Provider Demographics
NPI:1104978386
Name:KEYMER, MARY MACEDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MACEDA
Last Name:KEYMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W 142ND ST
Mailing Address - Street 2:17H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1104
Mailing Address - Country:US
Mailing Address - Phone:212-234-3390
Mailing Address - Fax:
Practice Address - Street 1:60 W 142ND ST
Practice Address - Street 2:APT 17H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1104
Practice Address - Country:US
Practice Address - Phone:212-234-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5302542282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital