Provider Demographics
NPI:1558886010
Name:KIESEL, LAURA ANN (CERTIFIED ASSESSOR)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:KIESEL
Suffix:
Gender:F
Credentials:CERTIFIED ASSESSOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MASSACHUSETTS AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8424
Mailing Address - Country:US
Mailing Address - Phone:617-649-6280
Mailing Address - Fax:
Practice Address - Street 1:792 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3137
Practice Address - Country:US
Practice Address - Phone:774-331-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor