Provider Demographics
NPI:1922474139
Name:WALDEN, KEEGAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEEGAN
Middle Name:
Last Name:WALDEN
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 1:24 ARDMORE PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1446
Mailing Address - Country:US
Mailing Address - Phone:415-948-7933
Mailing Address - Fax:
Practice Address - Street 1:552 LINDEN AVENUE
Practice Address - Street 2:EAST AURORA PSYCHOLOGICAL SERVICES
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2915
Practice Address - Country:US
Practice Address - Phone:716-667-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP98992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical