Healthcare Provider Details

I. General information

NPI: 1245329838
Provider Name (Legal Business Name): JASON WILLIAM KEICHER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 STRATTON RD
RUTLAND VT
05701-4621
US

IV. Provider business mailing address

10 NORTH MAIN ST
CORTLAND NY
13045
US

V. Phone/Fax

Practice location:
  • Phone: 800-468-9118
  • Fax:
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number068800
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0134169
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number085469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: