Provider Demographics
NPI:1760116412
Name:KEANEBOTTINO, MAUREEN MELINDA (RN, CT, CGE, COUNSEL)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MELINDA
Last Name:KEANEBOTTINO
Suffix:
Gender:F
Credentials:RN, CT, CGE, COUNSEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PURITAN DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 PURITAN DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2052
Practice Address - Country:US
Practice Address - Phone:617-968-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional