Provider Demographics
NPI:1043943251
Name:EISENSTADT, KATIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:EISENSTADT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W 68TH ST APT 29E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5835
Mailing Address - Country:US
Mailing Address - Phone:914-715-7736
Mailing Address - Fax:212-799-2942
Practice Address - Street 1:155 W 68TH ST APT 29E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5835
Practice Address - Country:US
Practice Address - Phone:914-715-7736
Practice Address - Fax:212-799-2942
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6597-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty