Provider Demographics
NPI:1548701428
Name:NESIC, NATASHA (MA, RMHCI, AT)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:
Last Name:NESIC
Suffix:
Gender:F
Credentials:MA, RMHCI, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BAYVIEW DR APT 1528
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5326
Mailing Address - Country:US
Mailing Address - Phone:786-333-9097
Mailing Address - Fax:
Practice Address - Street 1:100 BAYVIEW DR APT 1528
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-5326
Practice Address - Country:US
Practice Address - Phone:786-333-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15880101Y00000X
FL18-022221700000X
FLMH18239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty