Provider Demographics
NPI:1720295173
Name:FENSTERSTOCK, NAOMI NUNOKAWA (LMHC, CRC)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:NUNOKAWA
Last Name:FENSTERSTOCK
Suffix:
Gender:F
Credentials:LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N BROADWAY
Mailing Address - Street 2:APT 8B
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1239
Mailing Address - Country:US
Mailing Address - Phone:917-748-6905
Mailing Address - Fax:
Practice Address - Street 1:120 N BROADWAY
Practice Address - Street 2:APT 8B
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1239
Practice Address - Country:US
Practice Address - Phone:917-748-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002023-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health