Provider Demographics
NPI:1629196829
Name:SAMPSON-KELLER, ANGELA ELIZABETH (MPS, LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ELIZABETH
Last Name:SAMPSON-KELLER
Suffix:
Gender:F
Credentials:MPS, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 FREDERICK DOUGLASS BLVD
Mailing Address - Street 2:UNIT #1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-3496
Mailing Address - Country:US
Mailing Address - Phone:212-862-3206
Mailing Address - Fax:
Practice Address - Street 1:115 W 116TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2521
Practice Address - Country:US
Practice Address - Phone:212-961-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR060067-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator