Provider Demographics
NPI:1982841375
Name:KESTEMBERG, LAURA B (PHD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:KESTEMBERG
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 1:510 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1152
Mailing Address - Country:US
Mailing Address - Phone:516-437-6050
Mailing Address - Fax:516-437-6304
Practice Address - Street 1:510 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1152
Practice Address - Country:US
Practice Address - Phone:516-437-6050
Practice Address - Fax:516-437-6304
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013998103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical