Provider Demographics
NPI:1912731662
Name:KESSELL, STEPHANIE LOUISE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:KESSELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BROAD ST APT 1422
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-1973
Mailing Address - Country:US
Mailing Address - Phone:917-558-7212
Mailing Address - Fax:
Practice Address - Street 1:14 E 4TH ST RM 604
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1141
Practice Address - Country:US
Practice Address - Phone:917-558-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007506-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist