Provider Demographics
NPI:1710512454
Name:LINDEN, KELLEEN MARGUERITE
Entity Type:Individual
Prefix:
First Name:KELLEEN
Middle Name:MARGUERITE
Last Name:LINDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLEEN
Other - Middle Name:
Other - Last Name:LINDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:12670 NEW BRITTANY BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3650
Mailing Address - Country:US
Mailing Address - Phone:239-454-3655
Mailing Address - Fax:
Practice Address - Street 1:12670 NEW BRITTANY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3650
Practice Address - Country:US
Practice Address - Phone:239-454-3655
Practice Address - Fax:239-454-3655
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3014101YM0800X
FL103TP2701X
FLMT1455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy