Provider Demographics
NPI:1407851421
Name:KECK, LINDA S (MA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:KECK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:STE 214
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-718-1761
Mailing Address - Fax:570-718-1763
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:STE 214
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-718-1761
Practice Address - Fax:570-718-1763
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006098-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist