MEDICARE: ASHLEY KESSLER LMFT, CASAC

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	106H00000X	Marriage & Family Therapist	001083	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1891327540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KESSLER LMFT, CASAC

Provider Business Mailing Address
First Line	:	122 MAPLE LN
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3840
Country	:	US
Telephone Number	:	610-698-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 ERIE BLVD E STE C
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13224-1041
Country	:	US
Telephone Number	:	315-857-3035
Fax Number	:

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/11/2020

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