Provider Demographics
NPI:1154673374
Name:IMPERATI, NASTASSIA
Entity type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:
Last Name:IMPERATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 SHAFER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4618
Mailing Address - Country:US
Mailing Address - Phone:703-627-1463
Mailing Address - Fax:
Practice Address - Street 1:6 HANGAR WAY
Practice Address - Street 2:SUITE A
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2456
Practice Address - Country:US
Practice Address - Phone:703-627-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11210454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst