Healthcare Provider Details

I. General information

NPI: 1356084289
Provider Name (Legal Business Name): SBK PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 YORK AVE APT 17F
NEW YORK NY
10021-4041
US

IV. Provider business mailing address

536 OLD SAG HARBOR RD
SAG HARBOR NY
11963-2234
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-3071
  • Fax:
Mailing address:
  • Phone: 914-584-3071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. STELLA BRACCO KEITEL
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 914-584-3071