Provider Demographics
NPI:1942552922
Name:HALBERSTAM, YECHESKEL YAKOV (MHC)
Entity Type:Individual
Prefix:
First Name:YECHESKEL
Middle Name:YAKOV
Last Name:HALBERSTAM
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:YECHESKEL
Other - Middle Name:
Other - Last Name:HALBERSTAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3501 N 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1970 52ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1731
Practice Address - Country:US
Practice Address - Phone:718-360-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP83518101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health