Provider Demographics
NPI:1457373029
Name:KESEL, MARY ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:KESEL
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 1:877 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2933
Mailing Address - Country:US
Mailing Address - Phone:585-442-1616
Mailing Address - Fax:585-442-5032
Practice Address - Street 1:877 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2933
Practice Address - Country:US
Practice Address - Phone:585-442-1616
Practice Address - Fax:585-442-5032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0368261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7045330OtherAETNA
NY108794FKOtherPREFERRED CARE