Provider Demographics
NPI:1477674935
Name:KESTENBAUM, CLARICE JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARICE
Middle Name:JOAN
Last Name:KESTENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CLARICE
Other - Middle Name:JOAN
Other - Last Name:DINCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15 WEST 81 STREET
Mailing Address - Street 2:APT 14B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-873-1020
Mailing Address - Fax:212-501-0477
Practice Address - Street 1:15 WEST 81 STREET
Practice Address - Street 2:APT 14B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-873-1020
Practice Address - Fax:212-501-0477
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY879602084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry