Individual
BLAISE RASTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAC II
Contact information
Practice address
4475 BROADWAY ST LOT 51, BOULDER, CO 80304-4350
(720) 391-9951
Mailing address
4475 BROADWAY ST LOT 51, BOULDER, CO 80304-4350
(720) 391-9951
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACD.0001086
CO
Other
Enumeration date
02/22/2017
Last updated
01/23/2023
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