Provider Demographics
NPI:1689040859
Name:FISK, KEYLA GRAHAM ZINTECK (LCSW)
Entity type:Individual
Prefix:
First Name:KEYLA
Middle Name:GRAHAM ZINTECK
Last Name:FISK
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 1:3495 BAILEY AVE # 10A
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1129
Mailing Address - Country:US
Mailing Address - Phone:716-862-3124
Mailing Address - Fax:716-862-7853
Practice Address - Street 1:3495 BAILEY AVE # 10A
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-3124
Practice Address - Fax:716-862-7853
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0870171041C0700X
NY089064104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker