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NPI Code Detail

MEDICARE: ANDREW WILLIAM DIPASTENA MFT TEMP LICENSE

MEDICARE: ANDREW WILLIAM DIPASTENA MFT TEMP LICENSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2106H00000XMarriage & Family Therapist1914TN

General Provider Information

NPI Number : 1003577370
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW WILLIAM DIPASTENA MFT TEMP LICENSE
Provider Business Mailing Address
First Line : 725 EVERHART DR NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-1622
Country : US
Telephone Number : 423-544-0199
Fax Number :
Provider Business Practice Location Address
First Line : 2200 CHAMBLISS AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3874
Country : US
Telephone Number : 423-599-9347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2022
Last Update Date : 11/22/2023

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Directions to “ ANDREW WILLIAM DIPASTENA MFT TEMP LICENSE” Practice Location

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