Provider Demographics
NPI:1891856761
Name:KOESTERICH, JEANETTE (LCSW BCD)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:KOESTERICH
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MINOR CT
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1110
Mailing Address - Country:US
Mailing Address - Phone:845-623-7986
Mailing Address - Fax:
Practice Address - Street 1:15 MINOR CT
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1110
Practice Address - Country:US
Practice Address - Phone:845-623-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR00518311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N42491Medicare ID - Type Unspecified