Provider Demographics
NPI:1750313300
Name:KEYS, JUDITH A (LCSWR)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:KEYS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2201
Mailing Address - Country:US
Mailing Address - Phone:716-218-1450
Mailing Address - Fax:716-332-2820
Practice Address - Street 1:20 RICH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3020
Practice Address - Country:US
Practice Address - Phone:716-895-7715
Practice Address - Fax:716-893-1692
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030241501OtherUNIVERA
NY000590248001OtherCOMMUNITY BLUE
NY000590248001OtherCOMMUNITY BLUE
NY00030241501OtherUNIVERA