Provider Demographics
NPI:1760555429
Name:NESTELBAUM, LEAH SLIVKO (LICSW, PSYCHA)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:SLIVKO
Last Name:NESTELBAUM
Suffix:
Gender:F
Credentials:LICSW, PSYCHA
Other - Prefix:PROF
Other - First Name:LEAH
Other - Middle Name:SLIVKO
Other - Last Name:NESTELBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW,PSYCHA
Mailing Address - Street 1:2 5TH AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8855
Mailing Address - Country:US
Mailing Address - Phone:413-262-4123
Mailing Address - Fax:
Practice Address - Street 1:2 5TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:413-262-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO23566-11041C0700X
MA1109441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASLP23959Medicare UPIN