Provider Demographics
NPI:1942527072
Name:TESSIN, KIM MARIE I (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:TESSIN
Suffix:I
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1509
Mailing Address - Country:US
Mailing Address - Phone:845-458-5016
Mailing Address - Fax:845-565-0826
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-562-7326
Practice Address - Fax:845-565-0826
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054076-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical