Provider Demographics
NPI:1447841408
Name:TASTAN, YASEMIN (LMSW)
Entity type:Individual
Prefix:
First Name:YASEMIN
Middle Name:
Last Name:TASTAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3518
Mailing Address - Country:US
Mailing Address - Phone:631-874-0185
Mailing Address - Fax:631-909-4796
Practice Address - Street 1:408 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3518
Practice Address - Country:US
Practice Address - Phone:631-874-0185
Practice Address - Fax:631-909-4796
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111603-11041C0700X
NY111603103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty