Provider Demographics
NPI:1043536683
Name:KELLER, MARIA ANGELICA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:KELLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 CROWN POINT DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4203
Mailing Address - Country:US
Mailing Address - Phone:651-338-0913
Mailing Address - Fax:
Practice Address - Street 1:900 AMERICAN BLVD E STE 134
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1339
Practice Address - Country:US
Practice Address - Phone:651-338-0913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN161551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical