Individual
DR. RANDALL LAUREN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
11021 73RD RD APT 1J, FOREST HILLS, NY 11375-6369
(347) 645-2919
Mailing address
8510 34TH AVE, APT. 320, JACKSON HEIGHTS, NY 11372-3244
(347) 645-2919
(718) 334-5082
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
013488
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02165057
—
NY
Enumeration date
07/25/2006
Last updated
04/22/2008
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