Provider Demographics
NPI:1851446678
Name:KETEKU, SALIAN (MS)
Entity Type:Individual
Prefix:MS
First Name:SALIAN
Middle Name:
Last Name:KETEKU
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DONIZETTI PL
Mailing Address - Street 2:APT. 7A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2024
Mailing Address - Country:US
Mailing Address - Phone:917-428-0410
Mailing Address - Fax:
Practice Address - Street 1:120 EINSTEIN LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4927
Practice Address - Country:US
Practice Address - Phone:718-671-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling