Provider Demographics
NPI:1043453483
Name:DANNER, KEITH D (LCPCC, LADC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:DANNER
Suffix:
Gender:M
Credentials:LCPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CONGRESS ST
Mailing Address - Street 2:ROOM 307
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3566
Mailing Address - Country:US
Mailing Address - Phone:207-874-8784
Mailing Address - Fax:207-874-8913
Practice Address - Street 1:20 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2912
Practice Address - Country:US
Practice Address - Phone:207-874-8448
Practice Address - Fax:207-874-8975
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4070101YA0400X
MEXL4096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433435199Medicare PIN