Healthcare Provider Details

I. General information

NPI: 1457272247
Provider Name (Legal Business Name): MR. JACOB LEE QUESNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 WALL ST
KINGSTON NY
12401-3817
US

IV. Provider business mailing address

44 BLUE MOUNTAIN MNR
SAUGERTIES NY
12477-3853
US

V. Phone/Fax

Practice location:
  • Phone: 845-481-0481
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: