Healthcare Provider Details

I. General information

NPI: 1285996363
Provider Name (Legal Business Name): KESCIA IRENE PRIOLEAU M.S. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 190TH ST #22
BRONX NY
10468-4574
US

IV. Provider business mailing address

55 E 190TH ST #22
BRONX NY
10468-4574
US

V. Phone/Fax

Practice location:
  • Phone: 646-701-2291
  • Fax: 718-365-8943
Mailing address:
  • Phone: 646-701-2291
  • Fax: 718-365-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: