Provider Demographics
NPI:1124230529
Name:KESTENBAUM, LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:KESTENBAUM
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 1:142 W END AVE
Mailing Address - Street 2:APT. 19N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6103
Mailing Address - Country:US
Mailing Address - Phone:212-799-6373
Mailing Address - Fax:
Practice Address - Street 1:142 W END AVE
Practice Address - Street 2:APT. 19N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6103
Practice Address - Country:US
Practice Address - Phone:212-799-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6005103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV47831Medicare ID - Type Unspecified