Provider Demographics
NPI:1497130793
Name:BEZIO, KENNETH M (LMHC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:BEZIO
Suffix:
Gender:M
Credentials:LMHC
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 619
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0619
Mailing Address - Country:US
Mailing Address - Phone:518-618-2102
Mailing Address - Fax:
Practice Address - Street 1:22 US OVAL STE 218
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-5902
Practice Address - Country:US
Practice Address - Phone:518-561-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008536101YM0800X
NYP97907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty