Provider Demographics
NPI:1134303704
Name:SENIOR, KEISHA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:NICOLE
Last Name:SENIOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S GREELEY AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3346
Mailing Address - Country:US
Mailing Address - Phone:914-238-1699
Mailing Address - Fax:
Practice Address - Street 1:1 S GREELEY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3346
Practice Address - Country:US
Practice Address - Phone:914-238-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0776361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCY