Provider Demographics
NPI:1174484307
Name:ISTOMINA, NATALIYA (MHC-LP)
Entity type:Individual
Prefix:
First Name:NATALIYA
Middle Name:
Last Name:ISTOMINA
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:NATA
Other - Middle Name:
Other - Last Name:ISTOMINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC-LP
Mailing Address - Street 1:4 GILDER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2748
Mailing Address - Country:US
Mailing Address - Phone:838-910-8150
Mailing Address - Fax:914-259-5449
Practice Address - Street 1:4 GILDER ST STE 2
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2748
Practice Address - Country:US
Practice Address - Phone:838-910-8150
Practice Address - Fax:914-259-5449
Is Sole Proprietor?:No
Enumeration Date:2025-11-18
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP139790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health