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General NPI Number Information
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NPI Number | 1376201574
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Entity Type | Individual
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Provider Name | KECIA KESNER ASW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2021
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Last Update Date | 12/04/2021
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Provider Practice Location Address
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Address Line | 5429 S ST ANDREWS PL
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City | LOS ANGELES
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State | CA
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Zip | 90062-2641
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Country | US
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Telephone | 323-903-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 3136 S CAROLINA ST
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City | SAN PEDRO
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State | CA
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Zip | 90731-6735
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Country | US
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Telephone | 424-223-2327
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | U1118890
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License Number State | CA
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