Provider Demographics
NPI:1497941660
Name:KEELER, LINDA JEAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEAN
Last Name:KEELER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 POVERTY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1948
Mailing Address - Country:US
Mailing Address - Phone:203-910-3543
Mailing Address - Fax:203-263-6565
Practice Address - Street 1:30 POVERTY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2254
Practice Address - Country:US
Practice Address - Phone:203-910-3543
Practice Address - Fax:203-263-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008004566Medicaid
CT240001585CT02OtherANTHEM
CT11793020OtherHEALTHYCT
CT9536370OtherAETNA