Provider Demographics
NPI:1699925446
Name:GASTON, CARLINE Y
Entity type:Individual
Prefix:
First Name:CARLINE
Middle Name:Y
Last Name:GASTON
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:HJAHC
Mailing Address - Street 2:321 N. WARREN ST
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:
Practice Address - Street 1:HJAHC
Practice Address - Street 2:321 N. WARREN ST
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01055400363LF0000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health