Provider Demographics
NPI:1831522408
Name:KOESTNER, ERIC JOSEPH (MSED, BCBA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOSEPH
Last Name:KOESTNER
Suffix:
Gender:M
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SILVER BEECH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2786
Mailing Address - Country:US
Mailing Address - Phone:203-628-6491
Mailing Address - Fax:
Practice Address - Street 1:119 SILVER BEECH RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2786
Practice Address - Country:US
Practice Address - Phone:203-628-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-12-10033103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst