Provider Demographics
NPI:1265631782
Name:BIESECKER, CARROLL A (MS)
Entity Type:Individual
Prefix:
First Name:CARROLL
Middle Name:A
Last Name:BIESECKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:49 SMITH AVENUE
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-0204
Mailing Address - Country:US
Mailing Address - Phone:914-241-8922
Mailing Address - Fax:
Practice Address - Street 1:49 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2813
Practice Address - Country:US
Practice Address - Phone:914-241-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000335102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst