Provider Demographics
NPI:1831645175
Name:REEDER, KELSEY GLENN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:GLENN
Last Name:REEDER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 AMSTERDAM AVE FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5927
Mailing Address - Country:US
Mailing Address - Phone:347-560-0216
Mailing Address - Fax:
Practice Address - Street 1:1255 AMSTERDAM AVE FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5927
Practice Address - Country:US
Practice Address - Phone:347-560-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0879491041C0700X
NYR0879491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty