Provider Demographics
NPI:1629584982
Name:LASTER, ANNASTASIA CASSIDY (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ANNASTASIA
Middle Name:CASSIDY
Last Name:LASTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 38TH AVE N STE 102
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1570
Mailing Address - Country:US
Mailing Address - Phone:813-527-9638
Mailing Address - Fax:813-867-7288
Practice Address - Street 1:6705 38TH AVE N STE 102
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1570
Practice Address - Country:US
Practice Address - Phone:813-527-9638
Practice Address - Fax:813-867-7288
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17-32452106S00000X
FL106S00000X
FL1-20-45614103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician