Provider Demographics
NPI:1588135461
Name:FEASTER, IESHA (LMHC)
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:
Last Name:FEASTER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 NORTH PLANK RD
Mailing Address - Street 2:SUITE 1 PMB# 403
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6594
Mailing Address - Country:US
Mailing Address - Phone:845-522-7775
Mailing Address - Fax:
Practice Address - Street 1:2432 GRAND CONCOURSE RM 500
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:646-773-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-08-13
Deactivation Date:2020-04-29
Deactivation Code:
Reactivation Date:2020-12-09
Provider Licenses
StateLicense IDTaxonomies
NY009245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health