Individual
ANDREA BAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8002 KEW GARDENS RD, SUITE 704, KEW GARDENS, NY 11415-3600
(718) 520-1513
(718) 520-6460
Mailing address
PO BOX 417147, BOSTON, MA 02241-7147
(518) 952-8140
(518) 952-8287
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5765891
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03008151
—
NY
Enumeration date
12/13/2012
Last updated
12/13/2012
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