Provider Demographics
NPI:1578125332
Name:KELLER, ESTHER R (MSED BCBA)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:R
Last Name:KELLER
Suffix:
Gender:F
Credentials:MSED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUNVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5460
Mailing Address - Country:US
Mailing Address - Phone:845-517-9934
Mailing Address - Fax:
Practice Address - Street 1:128 MELVILLE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4235
Practice Address - Country:US
Practice Address - Phone:732-886-8113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst