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General NPI Number Information
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NPI Number | 1497501175
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Entity Type | Individual
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Provider Name | DR. EVA PASTALKOVA
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Gender |
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Dates
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Enumeration Date | 04/24/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1115 ELKTON DR STE 102
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-3597
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Country | US
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Telephone | 719-357-6471
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Fax |
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Provider Business Mailing Address
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Address Line | 24 HILL RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-5203
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Country | US
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Telephone | 540-236-4504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P121589
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY.0006533
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License Number State | CO
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