Healthcare Provider Details

I. General information

NPI: 1083370910
Provider Name (Legal Business Name): JULIA G KEFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 SOUTH ST FL 2
OYSTER BAY NY
11771-2254
US

IV. Provider business mailing address

52 HIGHWOOD RD
OYSTER BAY NY
11771-3802
US

V. Phone/Fax

Practice location:
  • Phone: 516-318-8057
  • Fax:
Mailing address:
  • Phone: 516-922-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107011-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: