Healthcare Provider Details

I. General information

NPI: 1902041775
Provider Name (Legal Business Name): CRYSTAL LYNN KEEFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 01/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 EAST AVE SUITE 303
ROCHESTER NY
14604
US

IV. Provider business mailing address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-434-2633
  • Fax:
Mailing address:
  • Phone: 585-368-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: