Healthcare Provider Details

I. General information

NPI: 1962941500
Provider Name (Legal Business Name): STEPHANIE KRESSER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

IV. Provider business mailing address

PO BOX 393
PORT EWEN NY
12466-0393
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-2568
  • Fax:
Mailing address:
  • Phone: 845-853-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number093462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: