Provider Demographics
NPI:1255695037
Name:FLIESSER, KENNETH HOWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:HOWARD
Last Name:FLIESSER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BELLOWS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2439
Mailing Address - Country:US
Mailing Address - Phone:845-638-1987
Mailing Address - Fax:845-678-1889
Practice Address - Street 1:104 BELLOWS LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2439
Practice Address - Country:US
Practice Address - Phone:845-638-1987
Practice Address - Fax:845-678-1889
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0775821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical