Individual
JENNIFER LYNN KELUSKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
37 RESEARCH WAY, EAST SETAUKET, NY 11733-3465
(631) 444-4660
(631) 444-4339
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-4660
(631) 444-4339
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
019292
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID PROVIDER #
NY
01
—
1285628552
AGENCY NPI #
NY
01
—
WVE061
AGENCY MEDICARE #
NY
Enumeration date
08/04/2009
Last updated
01/16/2014
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