Provider Demographics
NPI:1780161091
Name:KNESTEL, ANDREA (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KNESTEL
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-0003
Mailing Address - Country:US
Mailing Address - Phone:617-420-5258
Mailing Address - Fax:
Practice Address - Street 1:224 CLARENDON ST STE 51
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3793
Practice Address - Country:US
Practice Address - Phone:617-420-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7771439-2501103TC0700X
MA11051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical