MEDICARE: CONSTANZA KIESEL

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	104100000X	Social Worker	P84035	NY

General Provider Information

NPI Number	:	1528321205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANZA KIESEL

Provider Business Mailing Address
First Line	:	3 W 29TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-4560
Country	:	US
Telephone Number	:	212-725-7850
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 W 29TH ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-4560
Country	:	US
Telephone Number	:	212-725-7850
Fax Number	:

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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Directions to “ CONSTANZA KIESEL ” Practice Location

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