Provider Demographics
NPI:1073399234
Name:LACATIVA, KELSEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:LACATIVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:PASTORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 CHASE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4160
Mailing Address - Country:US
Mailing Address - Phone:917-620-8749
Mailing Address - Fax:
Practice Address - Street 1:1 CHASE RD STE 203
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4160
Practice Address - Country:US
Practice Address - Phone:914-572-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP123982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical