Amalia Maya Lastra
Social Worker, Clinical in Modesto, CA. Individual provider (NPI-1).
NPI number1871001024
StatusActive
Last updated in NPPESFeb 3, 2022
Details
- NPI
- 1871001024
- Entity type
- Individual (NPI-1)
- Name
- Amalia Maya Lastra
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 22, 2018
- Certification date
- Feb 3, 2022
- Last updated
- Feb 3, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 101067 | CA | Yes |
| 104100000X | Social Worker | ASW76891 | CA | |
| 101YP2500X | Counselor, Professional | ASW76891 | CA |
Practice location
800 Scenic DrModesto, CA 95350-6131
Phone 209-605-5543
Mailing address
Po Box 1859Modesto, CA 95353-1859
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