Provider Demographics
NPI:1235258021
Name:KESTENBAUM, JAMES DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:KESTENBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SULLYS TRL
Mailing Address - Street 2:BLDG. 10
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4552
Mailing Address - Country:US
Mailing Address - Phone:585-387-9700
Mailing Address - Fax:585-387-9691
Practice Address - Street 1:101 SULLYS TRL
Practice Address - Street 2:BLDG. 10
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4552
Practice Address - Country:US
Practice Address - Phone:585-387-9700
Practice Address - Fax:585-387-9691
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009690-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist