MEDICARE: DR. WARREN D KELLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	07489	NY

General Provider Information

NPI Number	:	1821090648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN D KELLER PH.D.

Provider Business Mailing Address
First Line	:	9750 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-2124
Country	:	US
Telephone Number	:	716-636-1375
Fax Number	:	716-636-4501

Provider Business Practice Location Address
First Line	:	8175 SHERIDAN DR
Second Line	:	STE 200
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6002
Country	:	US
Telephone Number	:	716-634-2600
Fax Number	:	716-634-2675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	04/08/2017

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