Provider Demographics
NPI:1316293608
Name:NASIATKA, CRYSTAL D (MA)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:NASIATKA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:508-791-4976
Mailing Address - Fax:
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:508-791-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health