Provider Demographics
NPI:1356795132
Name:KEATING, NIKI LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:NIKI
Middle Name:LYNN
Last Name:KEATING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1572 RANDALSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-2208
Mailing Address - Country:US
Mailing Address - Phone:315-559-1426
Mailing Address - Fax:
Practice Address - Street 1:40 MILFORD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1009
Practice Address - Country:US
Practice Address - Phone:315-559-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020902-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist