Provider Demographics
NPI:1982992889
Name:WENDY KELLER, LCSW, LLC
Entity Type:Organization
Organization Name:WENDY KELLER, LCSW, LLC
Other - Org Name:BEHAVIORAL HEALTH SERVICES OF THE HUDSON VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:845-242-8375
Mailing Address - Street 1:633 GIDNEY AVE STE 4-6
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2800
Mailing Address - Country:US
Mailing Address - Phone:845-242-8375
Mailing Address - Fax:866-619-5710
Practice Address - Street 1:633 GIDNEY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-242-8375
Practice Address - Fax:866-619-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0556931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7K211Medicare PIN