Provider Demographics
NPI:1376201574
Name:KESNER, KECIA (ASW)
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:
Last Name:KESNER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 S CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6735
Mailing Address - Country:US
Mailing Address - Phone:424-223-2327
Mailing Address - Fax:
Practice Address - Street 1:5429 S ST ANDREWS PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-2641
Practice Address - Country:US
Practice Address - Phone:323-903-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAU11188901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical