Provider Demographics
NPI:1588137343
Name:CESTNICK, LAURIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:CESTNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 NORTH ROAD
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:SUDBURY
Mailing Address - State:MASSACHUSETTS
Mailing Address - Zip Code:01776
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1156
Practice Address - Country:US
Practice Address - Phone:617-413-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10000649103G00000X, 103T00000X, 103TC2200X
CT4646103T00000X
MA3083103TB0200X
CT004626103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10000649Medicaid
CT4646OtherPSYCHOLOGIST LICENSE
MA10000649OtherPSYCHOLOGIST LICENSE
CT004626Medicaid