Healthcare Provider Details

I. General information

NPI: 1821090648
Provider Name (Legal Business Name): WARREN D KELLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 SHERIDAN DR STE 200
WILLIAMSVILLE NY
14221-6002
US

IV. Provider business mailing address

9750 TRANSIT RD
EAST AMHERST NY
14051-2124
US

V. Phone/Fax

Practice location:
  • Phone: 716-634-2600
  • Fax: 716-634-2675
Mailing address:
  • Phone: 716-636-1375
  • Fax: 716-636-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: