Healthcare Provider Details

I. General information

NPI: 1760329908
Provider Name (Legal Business Name): AMANDA KESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CRESCENT ST APT 2
ASTORIA NY
11102-4636
US

IV. Provider business mailing address

2501 CRESCENT ST APT 2
ASTORIA NY
11102-4636
US

V. Phone/Fax

Practice location:
  • Phone: 609-713-3345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: