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General NPI Number Information
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NPI Number | 1801752225
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Entity Type | Organization
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Legal Business Name | COLLEEN KELLER LCSW PLLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 38 E MAIN ST
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City | TRUMANSBURG
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State | NY
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Zip | 14886-9335
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Country | US
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Telephone | 607-205-8505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 524
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City | TRUMANSBURG
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State | NY
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Zip | 14886-0524
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Country | US
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Telephone | 607-205-8508
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN KELLER
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Credential | LCSW
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Telephone | 856-287-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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