Provider Demographics
NPI:1487790259
Name:EUSTACE, CECILIA O (PSY D)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:O
Last Name:EUSTACE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-0611
Mailing Address - Country:US
Mailing Address - Phone:914-962-3348
Mailing Address - Fax:914-962-4332
Practice Address - Street 1:7 FARESE WAY
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1201
Practice Address - Country:US
Practice Address - Phone:914-962-3348
Practice Address - Fax:914-962-4332
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0085561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3344400OtherCIGNA
001875OtherVALUE OPTIONS
10040904OtherCDPHP
1034117OtherMETRACOMP
4314843OtherAETNA
57545OtherUBH
60008556NYOtherANTHEM
WS0001036OtherSELECTPRO
703155OtherMTCE
NY00955091Medicaid
5C0900OtherHEALTHNET
IP332461OtherMAGELLAN
110786OtherMHN
Y047097OtherCHAMPUS
V50091OtherBLUE CROSS SHIELD
3440 7573OtherAPA
WS169OtherOXFORD
3344400OtherCIGNA