Provider Demographics
NPI:1598094112
Name:PARDUE, SARAH L KEATS (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:L KEATS
Last Name:PARDUE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:KEATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-756-4226
Mailing Address - Fax:
Practice Address - Street 1:37 MILL ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1914
Practice Address - Country:US
Practice Address - Phone:207-756-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3426101YM0800X
101YP2500X
MECC3868101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health