Provider Demographics
NPI:1760074850
Name:CHOUEKA, ESTEE NICOLE
Entity Type:Individual
Prefix:
First Name:ESTEE
Middle Name:NICOLE
Last Name:CHOUEKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2144
Mailing Address - Country:US
Mailing Address - Phone:516-965-5678
Mailing Address - Fax:
Practice Address - Street 1:55 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-2144
Practice Address - Country:US
Practice Address - Phone:516-965-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2919903103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty