Provider Demographics
NPI:1689493223
Name:KOSTESKI, KAMRYN PEARL
Entity type:Individual
Prefix:
First Name:KAMRYN
Middle Name:PEARL
Last Name:KOSTESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 LAKE BINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3935
Mailing Address - Country:US
Mailing Address - Phone:321-262-9252
Mailing Address - Fax:
Practice Address - Street 1:305 WAYMONT CT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3566
Practice Address - Country:US
Practice Address - Phone:954-850-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician