Provider Demographics
NPI:1669843470
Name:HENSL, KIRSTEN BROOKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:BROOKE
Last Name:HENSL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KURSTEN
Other - Middle Name:BROOKE
Other - Last Name:HENSL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 7158
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11802-7158
Mailing Address - Country:US
Mailing Address - Phone:610-316-0091
Mailing Address - Fax:
Practice Address - Street 1:151 HORN LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3438
Practice Address - Country:US
Practice Address - Phone:610-316-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist