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General NPI Number Information
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NPI Number | 1629584982
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Entity Type | Individual
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Provider Name | ANNASTASIA CASSIDY LASTER BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2017
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 6705 38TH AVE N STE 102
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1570
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Country | US
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Telephone | 813-527-9638
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Fax | 813-867-7288
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Provider Business Mailing Address
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Address Line | 6705 38TH AVE N STE 102
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1570
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Country | US
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Telephone | 813-527-9638
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Fax | 813-867-7288
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 17-32452
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-45614
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License Number State | FL
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