Provider Demographics
NPI:1235462664
Name:KEELY, MARIE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:KEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 THOMAS JONES WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2580
Mailing Address - Country:US
Mailing Address - Phone:610-560-8204
Mailing Address - Fax:610-560-8219
Practice Address - Street 1:479 THOMAS JONES WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2580
Practice Address - Country:US
Practice Address - Phone:610-560-8204
Practice Address - Fax:610-560-8219
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)