Provider Demographics
NPI:1043802127
Name:KEELEY PSYCHIATRY LLC
Entity Type:Organization
Organization Name:KEELEY PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMUBONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-671-9402
Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8344
Mailing Address - Country:US
Mailing Address - Phone:186-439-9383
Mailing Address - Fax:
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 250
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8344
Practice Address - Country:US
Practice Address - Phone:186-439-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty