MEDICARE: KEL MAISENBACHER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW1141265	MA
2	1041C0700X	Clinical Social Worker	089.0136642	VT
3	1041C0700X	Clinical Social Worker	086705-1	NY

General Provider Information

NPI Number	:	1285004374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEL MAISENBACHER LCSW

Provider Business Mailing Address
First Line	:	3210 30TH AVE # 2L
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-1562
Country	:	US
Telephone Number	:	518-821-5932
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 30TH AVE # 2L
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-1562
Country	:	US
Telephone Number	:	929-244-3779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	08/12/2025

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Directions to “ KEL MAISENBACHER LCSW” Practice Location

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