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General NPI Number Information
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NPI Number | 1497118350
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Entity Type | Organization
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Legal Business Name | KENNETH FLIESSER LCSW PC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 978 ROUTE 45
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City | POMONA
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State | NY
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Zip | 10970-3521
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Country | US
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Telephone | 845-709-8938
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Fax | 845-678-1889
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Provider Business Mailing Address
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Address Line | 104 BELLOWS LN
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City | NEW CITY
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State | NY
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Zip | 10956-2439
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Country | US
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Telephone | 845-709-8938
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Fax | 845-678-1889
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Authorized Official
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Title or Position | PRESIDENT/TREASURER
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Name | MR. KENNETH HOWARD FLIESSER
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Credential | LCSW
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Telephone | 845-709-8938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 076582
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License Number State | NY
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