Provider Demographics
NPI:1447274758
Name:KESSLER, JONATHAN PETER (LICSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PETER
Last Name:KESSLER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTRE STREET
Mailing Address - Street 2:C/O FULLER HOUSE
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-750-0308
Mailing Address - Fax:
Practice Address - Street 1:130 CENTRE ST
Practice Address - Street 2:C/O FULLER HOUSE
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1400
Practice Address - Country:US
Practice Address - Phone:978-750-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical