Provider Demographics
NPI:1538385372
Name:KIESSLING, PATRICIA (LICSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:KIESSLING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WASHINGTON ST STE 55
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1740
Mailing Address - Country:US
Mailing Address - Phone:781-290-3886
Mailing Address - Fax:781-836-5006
Practice Address - Street 1:80 WASHINGTON ST STE 55
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-290-3886
Practice Address - Fax:781-836-5006
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10220251041C0700X
MA1020251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid