Basic Information
| Provider Information | |||||||||
| NPI: | 1639429160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LESINSKI | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1199 OSTERVILLE WEST BARNSTABLE ROAD | ||||||||
| Address2: | |||||||||
| City: | MARSTONS MILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083671815 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 27 PARK ST | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026015230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088625000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 10099 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 609550001 | 05 | MD | MEDICAID | 609550002 | 05 | MD | MEDICAID | 609550004 | 05 | MD | MEDICAID |