Provider Demographics
NPI:1194939801
Name:KOBERSTEIN, KRISTIN L (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:KOBERSTEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2101
Mailing Address - Country:US
Mailing Address - Phone:585-397-5012
Mailing Address - Fax:
Practice Address - Street 1:243 CENTER ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2101
Practice Address - Country:US
Practice Address - Phone:585-397-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001025-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT419475OtherMHN
CT9890123OtherAETNA
CT410001242CT01OtherANTHEM BLUE CROSS