Provider Demographics
NPI:1295178143
Name:KEYSTONE, CAROLINE JEANNE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JEANNE
Last Name:KEYSTONE
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 1:1330 LINCOLN AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2120
Mailing Address - Country:US
Mailing Address - Phone:415-459-5999
Mailing Address - Fax:415-459-5602
Practice Address - Street 1:1330 LINCOLN AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2120
Practice Address - Country:US
Practice Address - Phone:415-459-5999
Practice Address - Fax:415-459-5602
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist