Active NPI
Sally Keller, PH.D.
- Clinical Psychologist
- Great Neck, NY
National Provider Identifier
1255405791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 015413-1
- Practice address
- 5 Bond St
Ste. 4
Great Neck, NY 11021-2420 - Phone
- (516) 244-4148
- Fax
- (925) 889-2838
- NPI assigned
- Nov 17, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 015413-1 | NY | Primary |
Addresses
Primary practice location
5 Bond St
Ste. 4
Great Neck, NY 11021-2420
Mailing address
43 North Dr
Great Neck, NY 11021-1333
Phone (516) 244-4148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2017 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015413 | NY | MD | Community Health Worker |
| 015413-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255405791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 NORTH DR",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110211333",
"telephone_number": "516-244-4148",
"fax_number": "925-889-2838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 BOND ST",
"address_2": "STE. 4",
"city": "GREAT NECK",
"state": "NY",
"postal_code": "110212420",
"telephone_number": "516-244-4148",
"fax_number": "925-889-2838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "SALLY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "015413-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Neck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.