Provider Demographics
NPI:1932472735
Name:KELLER, MEGAN RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:RENEE
Last Name:KELLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:E ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-2171
Mailing Address - Country:US
Mailing Address - Phone:585-278-8028
Mailing Address - Fax:
Practice Address - Street 1:129 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:E ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-2171
Practice Address - Country:US
Practice Address - Phone:585-278-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078370-11041S0200X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool