Provider Demographics
NPI:1518012707
Name:BARBARA KEEZELL, PC
Entity Type:Organization
Organization Name:BARBARA KEEZELL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-730-9400
Mailing Address - Street 1:1415 BEACON ST
Mailing Address - Street 2:ROOM 302
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4816
Mailing Address - Country:US
Mailing Address - Phone:617-730-9400
Mailing Address - Fax:
Practice Address - Street 1:1415 BEACON ST
Practice Address - Street 2:ROOM 302
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4816
Practice Address - Country:US
Practice Address - Phone:617-730-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO3843OtherBLUE CROSSBLUE SHIELD
MA=========01OtherPACIFICARE
MAPO3843Medicare ID - Type Unspecified