Provider Demographics
NPI:1699961698
Name:BERNABE CRASTA, GLADYS (LCSW/MSW)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:BERNABE CRASTA
Suffix:
Gender:F
Credentials:LCSW/MSW
Other - Prefix:
Other - First Name:GLADYS
Other - Middle Name:BERNABE
Other - Last Name:CRASTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW MSW
Mailing Address - Street 1:265 ROUTE 36 STE 106
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1042
Mailing Address - Country:US
Mailing Address - Phone:848-456-4601
Mailing Address - Fax:848-456-4607
Practice Address - Street 1:265 ROUTE 36 STE 106
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1042
Practice Address - Country:US
Practice Address - Phone:848-456-4601
Practice Address - Fax:848-456-4607
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008612001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ244870Medicare UPIN