MEDICARE: LINDA NASTARI LCSW

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
1	1041C0700X	Clinical Social Worker	LCS11384	CA

General Provider Information

NPI Number	:	1720456239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA NASTARI LCSW

Provider Business Mailing Address
First Line	:	PO BOX 6243
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95150-6243
Country	:	US
Telephone Number	:	408-358-5414
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 COLLINGWOOD AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3807
Country	:	US
Telephone Number	:	408-358-5414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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