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General NPI Number Information
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NPI Number | 1467525972
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Entity Type | Organization
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Legal Business Name | ALBERT J KASTL PHD INC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1107 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-4805
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Country | US
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Telephone | 707-528-2144
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Fax | 707-527-8667
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Provider Business Mailing Address
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Address Line | 1107 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95405-4805
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Country | US
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Telephone | 707-528-2144
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Fax | 707-527-8667
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERT JOSEPH KASTL
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Credential | PHD
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Telephone | 707-528-2144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY3209
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License Number State | CA
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