Provider Demographics
NPI:1881917839
Name:STEUBEN, KELLI J (LMHC)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:J
Last Name:STEUBEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:J
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:196 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1230
Mailing Address - Country:US
Mailing Address - Phone:518-439-0033
Mailing Address - Fax:
Practice Address - Street 1:196 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1230
Practice Address - Country:US
Practice Address - Phone:518-439-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY005179-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)