Provider Demographics
NPI:1821090648
Name:KELLER, WARREN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:D
Last Name:KELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2124
Mailing Address - Country:US
Mailing Address - Phone:716-636-1375
Mailing Address - Fax:716-636-4501
Practice Address - Street 1:8175 SHERIDAN DR
Practice Address - Street 2:STE 200
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6002
Practice Address - Country:US
Practice Address - Phone:716-634-2600
Practice Address - Fax:716-634-2675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist