Provider Demographics
NPI:1285721696
Name:KISIEL, STANLEY CHESTER JR (LMFT)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:CHESTER
Last Name:KISIEL
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
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Mailing Address - Street 1:65 HIGH GATE RD
Mailing Address - Street 2:C4
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5252
Mailing Address - Country:US
Mailing Address - Phone:860-594-8915
Mailing Address - Fax:
Practice Address - Street 1:416 HIGHLAND AVE
Practice Address - Street 2:BUILDING B, SUITE 6
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:860-595-6363
Practice Address - Fax:860-426-8661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000438 B000602OtherSAGA GRP
CT004052015Medicaid
CT77ABH0021CT01OtherANTHEM
CTANC1482OtherOXFORD HEALTH PLANS
CT269952OtherMANAGED HEALTH NETWORK