Provider Demographics
NPI:1356084289
Name:SBK PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:SBK PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:BRACCO
Authorized Official - Last Name:KEITEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:914-584-3071
Mailing Address - Street 1:536 OLD SAG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-2234
Mailing Address - Country:US
Mailing Address - Phone:914-584-3071
Mailing Address - Fax:
Practice Address - Street 1:1365 YORK AVE APT 17F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4041
Practice Address - Country:US
Practice Address - Phone:914-584-3071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty