Provider Demographics
NPI:1053923458
Name:SAUL MERDASSI, LESTINA LEONA (LADC)
Entity type:Individual
Prefix:
First Name:LESTINA
Middle Name:LEONA
Last Name:SAUL MERDASSI
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:LESTINA
Other - Middle Name:LEONA
Other - Last Name:SAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 LANDON CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2414
Mailing Address - Country:US
Mailing Address - Phone:402-346-0902
Mailing Address - Fax:402-342-5290
Practice Address - Street 1:2240 LANDON CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2414
Practice Address - Country:US
Practice Address - Phone:402-346-0902
Practice Address - Fax:402-342-5290
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)