Provider Demographics
NPI:1396877601
Name:KUESELL, HANS-RAINER (PHD, PHD)
Entity type:Individual
Prefix:PROF
First Name:HANS-RAINER
Middle Name:
Last Name:KUESELL
Suffix:
Gender:M
Credentials:PHD, PHD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:RAINER
Other - Last Name:KUESELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PHD
Mailing Address - Street 1:130 FT. WASHINGTON AVENUE
Mailing Address - Street 2:5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4753
Mailing Address - Country:US
Mailing Address - Phone:212-568-7714
Mailing Address - Fax:212-568-7714
Practice Address - Street 1:130 FT. WASHINGTON AVENUE
Practice Address - Street 2:5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4753
Practice Address - Country:US
Practice Address - Phone:212-568-7714
Practice Address - Fax:212-568-7714
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014097-1103T00000X
174400000X
NY014097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553611Medicaid