Provider Demographics
NPI:1619616745
Name:LEBEL, KERSTIN GISELA (RBT)
Entity Type:Individual
Prefix:MS
First Name:KERSTIN
Middle Name:GISELA
Last Name:LEBEL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 DERBY AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-2084
Mailing Address - Country:US
Mailing Address - Phone:203-915-8182
Mailing Address - Fax:
Practice Address - Street 1:666 STATE ST
Practice Address - Street 2:UNIT A3
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT633851106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician