Provider Demographics
NPI:1760885164
Name:BIENSTOCK, CARYN R
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:R
Last Name:BIENSTOCK
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 1:1 CROCKETT STREET
Mailing Address - Street 2:
Mailing Address - City:ROWAYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06853-1632
Mailing Address - Country:US
Mailing Address - Phone:203-838-4122
Mailing Address - Fax:203-838-1072
Practice Address - Street 1:95 ROWAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:ROWAYTON
Practice Address - State:CT
Practice Address - Zip Code:06853-1632
Practice Address - Country:US
Practice Address - Phone:203-838-4122
Practice Address - Fax:203-838-1072
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0001501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTR34594Medicare UPIN