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General NPI Number Information
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NPI Number | 1922474139
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Entity Type | Individual
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Provider Name | KEEGAN WALDEN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 552 LINDEN AVENUE EAST AURORA PSYCHOLOGICAL SERVICES
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City | EAST AURORA
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State | NY
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Zip | 14052-2915
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Country | US
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Telephone | 716-667-2105
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Fax |
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Provider Business Mailing Address
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Address Line | 24 ARDMORE PL
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City | BUFFALO
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State | NY
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Zip | 14213-1446
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Country | US
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Telephone | 415-948-7933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P98992
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License Number State | NY
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