MEDICARE: CLARE KELLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102992	NY

General Provider Information

NPI Number	:	1750094868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE KELLER LCSW

Provider Business Mailing Address
First Line	:	79 MIDDLEVILLE RD # SWS122
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2200
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	79 MIDDLEVILLE RD # SWS122
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2200
Country	:	US
Telephone Number	:	631-261-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	05/07/2026

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