Provider Demographics
NPI:1821151457
Name:FESTA, JOANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:FESTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W 59TH ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8022
Mailing Address - Country:US
Mailing Address - Phone:212-523-8060
Mailing Address - Fax:212-523-6962
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8022
Practice Address - Country:US
Practice Address - Phone:212-523-8060
Practice Address - Fax:212-523-6962
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014394-1103T00000X, 103TB0200X, 103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02153657Medicaid
NYVL3911Medicare ID - Type Unspecified