Provider Demographics
NPI:1578764841
Name:KEITH, DEBORAH JANE (LP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JANE
Last Name:KEITH
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINEHURST AVE
Mailing Address - Street 2:APT. 62
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1805
Mailing Address - Country:US
Mailing Address - Phone:212-877-6332
Mailing Address - Fax:
Practice Address - Street 1:249 W 34TH ST
Practice Address - Street 2:604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2815
Practice Address - Country:US
Practice Address - Phone:917-612-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000274102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst