Provider Demographics
NPI:1962510461
Name:KIESSLING, MARY CONSTANCE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CONSTANCE
Last Name:KIESSLING
Suffix:
Gender:F
Credentials:LCSW
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 10787
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-0787
Mailing Address - Country:US
Mailing Address - Phone:585-922-1122
Mailing Address - Fax:585-922-1985
Practice Address - Street 1:224 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-4002
Practice Address - Country:US
Practice Address - Phone:585-922-7770
Practice Address - Fax:585-922-1985
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0741891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical