Healthcare Provider Details

I. General information

NPI: 1821151457
Provider Name (Legal Business Name): JOANNE FESTA PHD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST SUITE 6A
NEW YORK NY
10019-8022
US

IV. Provider business mailing address

425 W 59TH ST SUITE 6A
NEW YORK NY
10019-8022
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-8060
  • Fax: 212-523-6962
Mailing address:
  • Phone: 212-523-8060
  • Fax: 212-523-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014394-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number014394-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014394-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number014394-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: