Provider Demographics
NPI:1184076358
Name:PSYPROBILL, LLC
Entity type:Organization
Organization Name:PSYPROBILL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-569-2900
Mailing Address - Street 1:633 GIDNEY AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2800
Mailing Address - Country:US
Mailing Address - Phone:845-569-2900
Mailing Address - Fax:866-619-5710
Practice Address - Street 1:633 GIDNEY AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2800
Practice Address - Country:US
Practice Address - Phone:845-569-2900
Practice Address - Fax:866-619-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154287251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health