Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 002747 | NY |
N | 103TS0200X | School Psychologist | 14006 | NY |
NPI | 1003338161 |
---|---|
Provider Name | Soudabeh Shayesteh |
First Address | Brooklyn, NY 11215-0417 |
Second Address | Brooklyn, NY 11215-2836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 20/07/2017 |