Provider Demographics
NPI:1447458625
Name:GORENSTEIN-HOLTZMAN, MICHELLE L (PSY,D)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:GORENSTEIN-HOLTZMAN
Suffix:
Gender:F
Credentials:PSY,D
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GORENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4002
Mailing Address - Country:US
Mailing Address - Phone:212-273-2766
Mailing Address - Fax:
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:212-273-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018676103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist