Provider Demographics
NPI:1386069219
Name:PYTAL, ANASTASIA RAISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:RAISA
Last Name:PYTAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W COHAWKIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1145
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-0823
Practice Address - Street 1:39 EAST MAIN STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-2206
Practice Address - Country:US
Practice Address - Phone:973-454-5569
Practice Address - Fax:856-423-0823
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004880103T00000X
MD708895103T00000X
NY8355061103T00000X
NJ5288103T00000X
DCPSY1000880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist