Provider Demographics
NPI:1710588975
Name:DESSAUER, KALEY (LICSW)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:DESSAUER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 WASHINGTON ST # 303
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 WELLS AVE STE 1
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3263
Practice Address - Country:US
Practice Address - Phone:781-731-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-03-31
Deactivation Date:2020-11-04
Deactivation Code:
Reactivation Date:2021-03-31
Provider Licenses
StateLicense IDTaxonomies
MA1227811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical