Provider Demographics
NPI:1417152513
Name:KESSEL, KENNETH A (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:KESSEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTH BROOM STREET
Mailing Address - Street 2:#16
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3424
Mailing Address - Country:US
Mailing Address - Phone:646-286-8015
Mailing Address - Fax:
Practice Address - Street 1:900 NORTH BROOM STREET
Practice Address - Street 2:#16
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806
Practice Address - Country:US
Practice Address - Phone:646-286-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052381041C0700X
NYR-0302071041C0700X
DEQ1-0012991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106343Medicaid