Provider Demographics
NPI:1982649828
Name:KAWESCH, PHILIP (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:KAWESCH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-1003
Mailing Address - Country:US
Mailing Address - Phone:914-738-0561
Mailing Address - Fax:718-792-2496
Practice Address - Street 1:23 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1003
Practice Address - Country:US
Practice Address - Phone:914-763-8942
Practice Address - Fax:914-738-0561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024736-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN02552Medicare ID - Type Unspecified