Provider Demographics
NPI:1053183582
Name:GIRELLLI, MIKAYLA KESTEN (PSYD)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:KESTEN
Last Name:GIRELLLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2613
Mailing Address - Country:US
Mailing Address - Phone:917-410-0282
Mailing Address - Fax:
Practice Address - Street 1:408 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2613
Practice Address - Country:US
Practice Address - Phone:917-410-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P125618-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical