Individual provider Active NPI

Mary Monaco Keller, ED.D.

  • Clinical Psychologist
  • Westbury, NY
National Provider Identifier
1043254089
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
015524 Issued in NY
Practice address
55 Post Ave
Suite #205
Westbury, NY 11590-4361
Phone
(631) 921-8561
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 015524 NY Primary

Addresses

Primary practice location

55 Post Ave
Suite #205
Westbury, NY 11590-4361

Mailing address

4 Oak PL
Southampton, NY 11968-1525
Phone (631) 283-3296

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061020000430 NY Practitioner - Clinical Psychologist 8527083112 Practice locations: Southampton, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4 Oak PL
Southampton, NY 11968-1525
Phone (631) 259-2122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Physical Therapy PC Past Accepting new patients
Aron Rovner MD PLLC PastSince Jul 1, 2013 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1043254089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 OAK PL",
            "city": "SOUTHAMPTON",
            "state": "NY",
            "postal_code": "119681525",
            "telephone_number": "631-283-3296",
            "fax_number": "631-283-3296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 POST AVE",
            "address_2": "SUITE #205",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115904361",
            "telephone_number": "631-921-8561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLER",
        "first_name": "MARY",
        "middle_name": "MONACO",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbury, NY

Sources for this page

Verify at the official NPI Registry.