Provider Demographics
NPI:1134130040
Name:SHESTOPAL, ARYEH (PHD)
Entity Type:Individual
Prefix:MR
First Name:ARYEH
Middle Name:
Last Name:SHESTOPAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ARI
Other - Middle Name:
Other - Last Name:SHESTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:39 CLEARWATER ROARD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-564-0341
Mailing Address - Fax:617-431-4967
Practice Address - Street 1:39 CLEARWATER ROARD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-564-0341
Practice Address - Fax:617-431-4967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist