Healthcare Provider Details

I. General information

NPI: 1295807337
Provider Name (Legal Business Name): LISA ANNE KEENAN-USCHOLD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215-3021
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3216
  • Fax: 716-898-3259
Mailing address:
  • Phone: 716-898-3216
  • Fax: 716-898-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016005-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: