Provider Demographics
NPI:1134457963
Name:KEILSON, RAIZEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RAIZEL
Middle Name:
Last Name:KEILSON
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 1:156 BEACH 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5636
Mailing Address - Country:US
Mailing Address - Phone:347-695-9700
Mailing Address - Fax:347-695-9701
Practice Address - Street 1:156 BEACH 9TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5636
Practice Address - Country:US
Practice Address - Phone:347-695-9700
Practice Address - Fax:347-695-9701
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0828301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical