Provider Demographics
NPI:1124844493
Name:BASTOS, KATRINA LECHOWSKA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LECHOWSKA
Last Name:BASTOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BILLY PYLE RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-3520
Mailing Address - Country:US
Mailing Address - Phone:850-264-0100
Mailing Address - Fax:
Practice Address - Street 1:113 BILLY PYLE RD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-3520
Practice Address - Country:US
Practice Address - Phone:850-264-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW012188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker