Provider Demographics
NPI:1164586582
Name:KEELER, THERESA (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KEELER
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:2138 PRIEST BRIDGE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2462
Mailing Address - Country:US
Mailing Address - Phone:301-728-9983
Mailing Address - Fax:301-357-8560
Practice Address - Street 1:2138 PRIEST BRIDGE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2462
Practice Address - Country:US
Practice Address - Phone:301-728-9983
Practice Address - Fax:301-357-8560
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD668495Medicaid