Provider Demographics
NPI:1649555855
Name:KERI ANNE ISRAELSKI PSYD LLC
Entity type:Organization
Organization Name:KERI ANNE ISRAELSKI PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYD
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ISRAELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-308-4410
Mailing Address - Street 1:5310 WARD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1832
Mailing Address - Country:US
Mailing Address - Phone:303-278-7418
Mailing Address - Fax:888-341-5050
Practice Address - Street 1:7935 E PRENTICE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2708
Practice Address - Country:US
Practice Address - Phone:773-308-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty