Provider Demographics
NPI:1891321931
Name:RADER-GIBERSON, LESA (LMHC)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:RADER-GIBERSON
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 1:2 OVERLOOK RD APT 1D7
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2456
Mailing Address - Country:US
Mailing Address - Phone:917-733-2218
Mailing Address - Fax:
Practice Address - Street 1:2 OVERLOOK RD APT 1D7
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2456
Practice Address - Country:US
Practice Address - Phone:914-266-0619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health