Provider Demographics
NPI:1831275163
Name:WLADYKA KELTON, PATRICIA (MSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:WLADYKA KELTON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:29 GARFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1513
Mailing Address - Country:US
Mailing Address - Phone:516-674-0483
Mailing Address - Fax:
Practice Address - Street 1:1005 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1585
Practice Address - Country:US
Practice Address - Phone:516-676-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0237921041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
6262654OtherUNITED BEHAVIORAL HEALTH
6262654OtherUNITED BEHAVIORAL HEALTH