Provider Demographics
NPI:1114024296
Name:KEANE-DREYER, JERALDINE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERALDINE
Middle Name:S
Last Name:KEANE-DREYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-0096
Mailing Address - Country:US
Mailing Address - Phone:207-655-9008
Mailing Address - Fax:207-655-9005
Practice Address - Street 1:32 TANDBERG TRL
Practice Address - Street 2:SUITE 4
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6417
Practice Address - Country:US
Practice Address - Phone:207-655-9008
Practice Address - Fax:207-655-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPSY625103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling