Provider Demographics
NPI:1669451829
Name:KESSLER, JOHN C (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:KESSLER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 S OLD MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4941
Mailing Address - Country:US
Mailing Address - Phone:610-566-4975
Mailing Address - Fax:610-566-8816
Practice Address - Street 1:1033 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1404
Practice Address - Country:US
Practice Address - Phone:610-566-4975
Practice Address - Fax:610-566-8816
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0121591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE686303Medicare ID - Type Unspecified