Provider Demographics
NPI:1841367562
Name:FESTA, LAUREN E (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:FESTA
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 1:4 WAGON WHEEL TRL
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5330
Mailing Address - Country:US
Mailing Address - Phone:203-984-2129
Mailing Address - Fax:
Practice Address - Street 1:4 WAGON WHEEL TRL
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5330
Practice Address - Country:US
Practice Address - Phone:203-984-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical