Provider Demographics
NPI:1740509652
Name:KIESLING, STEPHEN MOSELEY (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MOSELEY
Last Name:KIESLING
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:CHILD PSYCHIATRY CLINIC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-4910
Mailing Address - Fax:212-562-8653
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:CHILD PSYCHIATRY CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-4910
Practice Address - Fax:212-562-8653
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048387-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical