=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285760348
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL A NASTASIO MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 STATE ROUTE 36 SUITE 201
-----------------------------------------------------
City | WEST LONG BRANCH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07764-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-935-7222
-----------------------------------------------------
Fax | 732-774-3292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 STATE ROUTE 36 SUITE 201
-----------------------------------------------------
City | WEST LONG BRANCH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07764-1036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-935-7222
-----------------------------------------------------
Fax | 732-774-3292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SC04300800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------