Healthcare Provider Details

I. General information

NPI: 1427153709
Provider Name (Legal Business Name): ROGER KESSLER L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD VAMC-PHOENIX, PTSD/PCT PROGRAM
PHOENIX AZ
85012-8192
US

IV. Provider business mailing address

7300 N DREAMY DRAW DR UNIT # 104
PHOENIX AZ
85020-5243
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-222-2723
Mailing address:
  • Phone: 602-277-5551
  • Fax: 602-944-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number#LCSW 1188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: