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General NPI Number Information
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NPI Number | 1588135461
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Entity Type | Individual
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Provider Name | IESHA FEASTER LMHC
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 2432 GRAND CONCOURSE RM 500
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City | BRONX
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State | NY
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Zip | 10458-5204
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Country | US
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Telephone | 646-773-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 56 NORTH PLANK RD SUITE 1 PMB# 403
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City | NEWBURGH
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State | NY
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Zip | 12550-6594
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Country | US
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Telephone | 845-522-7775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009245
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License Number State | NY
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