Provider Demographics
NPI:1912204868
Name:BATTLES, KEITH ANTHONY SR (CASAC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ANTHONY
Last Name:BATTLES
Suffix:SR
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BAY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2503
Mailing Address - Country:US
Mailing Address - Phone:718-981-6861
Mailing Address - Fax:718-981-6852
Practice Address - Street 1:148 BAY ST FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2503
Practice Address - Country:US
Practice Address - Phone:718-981-6861
Practice Address - Fax:718-981-6852
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)