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General NPI Number Information
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NPI Number | 1740773266
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Entity Type | Organization
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Legal Business Name | ANDREW M. KEOGH LICENSED CLINCIAL SOCIAL WORKER P.C.
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 06/09/2018
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Provider Practice Location Address
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Address Line | 21 LINWOOD AVE
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6501
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Country | US
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Telephone | 716-243-8147
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Fax | 716-626-4271
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Provider Business Mailing Address
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Address Line | 673 MOORE AVE
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City | BUFFALO
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State | NY
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Zip | 14223-1803
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Country | US
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Telephone | 716-868-8654
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW KEOGH
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Credential | LCSW
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Telephone | 716-868-8654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 074180
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License Number State | NY
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