Provider Demographics
NPI:1538233952
Name:KEALEY, CYNTHIA B (APRN BC PSYCH CLINIC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:B
Last Name:KEALEY
Suffix:
Gender:F
Credentials:APRN BC PSYCH CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:631-589-6631
Mailing Address - Fax:
Practice Address - Street 1:1919 MIDDLE COUNTRY RD
Practice Address - Street 2:STE 202
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:631-589-1203
Practice Address - Fax:631-467-5105
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4500101YA0400X
NYF4000561363LP0808X
NY2350651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered163W00000XNursing Service ProvidersRegistered Nurse