Provider Demographics
NPI:1124230552
Name:KEATING, MERREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MERREN
Middle Name:
Last Name:KEATING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MERREN
Other - Middle Name:
Other - Last Name:KEATING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:3 WILLIAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308
Mailing Address - Country:US
Mailing Address - Phone:718-227-9779
Mailing Address - Fax:
Practice Address - Street 1:3 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3142
Practice Address - Country:US
Practice Address - Phone:718-227-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008955-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV40133Medicare ID - Type Unspecified
NYV41033Medicare PIN