Keller, Randall Lauren

Keller, Randall Lauren is an sole proprietor health care provider with primary practice located at 11021 73Rd Rd Apt 1J , Forest Hills NY 11375-6369. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Keller, Randall Lauren can be contacted via phone (347) 645-2919.

Contact Information

Primary practice address
11021 73Rd Rd Apt 1J Forest Hills NY 11375-6369
Phone: (347) 645-2919
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 013488 New York

Profile Details

NPI number 1407879281
LBN Legal business name Keller, Randall Lauren
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 25th, 2006
Last updated Apr 22nd, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407879281 NPPES
New York MEDICAID 02165057

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