Healthcare Provider Details

I. General information

NPI: 1740516632
Provider Name (Legal Business Name): STACIE W KESSLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 W 34TH ST PENTHOUSE SUITE
NEW YORK NY
10001-3006
US

IV. Provider business mailing address

108 DONCASTER RD
MALVERNE NY
11565-1056
US

V. Phone/Fax

Practice location:
  • Phone: 202-321-0421
  • Fax:
Mailing address:
  • Phone: 202-321-0421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: