1548286479 NPI number — MS. CAROL C KEELER LCSW

Table of content: MS. CAROL C KEELER LCSW (NPI 1548286479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548286479 NPI number — MS. CAROL C KEELER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEELER
Provider First Name:
CAROL
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548286479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 E NEW ENGLAND AVE
Provider Second Line Business Mailing Address:
SUITE 225
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32789-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-629-5244
Provider Business Mailing Address Fax Number:
407-699-9429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 E NEW ENGLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 225
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-629-5244
Provider Business Practice Location Address Fax Number:
407-699-9429
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW1306 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067117 . This is a "VALUE OPTIONS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 62-39813 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7328420 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: A140685 . This is a "MAGELLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4203167 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 593048590327890000 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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