Provider Demographics
NPI:1184649642
Name:PREISLER, ROBERTA (PH D)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:PREISLER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIERREPONT STREET
Mailing Address - Street 2:APT 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-834-8145
Mailing Address - Fax:
Practice Address - Street 1:173 HICKS STREET
Practice Address - Street 2:OFFICE C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-834-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0080311103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7337265OtherGHI
V91531Medicare ID - Type Unspecified