Provider Demographics
NPI:1407094949
Name:WOSNESKI, KENNETH EDWARD (LMHC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:EDWARD
Last Name:WOSNESKI
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1019
Mailing Address - Country:US
Mailing Address - Phone:315-652-6233
Mailing Address - Fax:
Practice Address - Street 1:3070 RTE 31 BELGIUM ROAD
Practice Address - Street 2:UPSTATE PSYCHIATRIC CARE
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-638-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002940-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health