Provider Demographics
NPI:1083229660
Name:KELSEY G REEDER, LCSW
Entity Type:Organization
Organization Name:KELSEY G REEDER, LCSW
Other - Org Name:KELSEY G REEDER, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHODYNAMIC PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:347-560-0216
Mailing Address - Street 1:1255 AMSTERDAM AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5927
Mailing Address - Country:US
Mailing Address - Phone:347-560-0216
Mailing Address - Fax:
Practice Address - Street 1:1255 AMSTERDAM AVE FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5927
Practice Address - Country:US
Practice Address - Phone:347-560-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831645175OtherNPI