Provider Demographics
NPI:1639690043
Name:FOREST HILLS DBT CENTER
Entity Type:Organization
Organization Name:FOREST HILLS DBT CENTER
Other - Org Name:VANYA KRASTEVA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTEVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:814-503-0986
Mailing Address - Street 1:7405 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2636
Mailing Address - Country:US
Mailing Address - Phone:814-503-0986
Mailing Address - Fax:917-725-9299
Practice Address - Street 1:7405 METROPOLITAN AVE STE 2F
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2636
Practice Address - Country:US
Practice Address - Phone:814-503-0986
Practice Address - Fax:917-725-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084403101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY900942417OtherINSURANCE
NY225401831930455Medicaid