Provider Demographics
NPI:1760252522
Name:FRAWLEY, KEITH STEVEN (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:STEVEN
Last Name:FRAWLEY
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 GREEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-6213
Mailing Address - Country:US
Mailing Address - Phone:518-755-4265
Mailing Address - Fax:
Practice Address - Street 1:448 GREEN LAKE RD
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-6213
Practice Address - Country:US
Practice Address - Phone:518-755-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402730-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health