Provider Demographics
NPI:1275618209
Name:KEELEY, SUZANNE LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:LOUISE
Last Name:KEELEY
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 1:8600 SW 92ND STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-595-5155
Mailing Address - Fax:305-595-6455
Practice Address - Street 1:8600 SW 92ND STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-595-5155
Practice Address - Fax:305-595-6455
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
75910OtherBCBS
P1474248OtherOXFORD
75910Medicare ID - Type Unspecified