Provider Demographics
NPI:1780676130
Name:TAYLOR, KEITH P (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:59 CHURCH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3724
Mailing Address - Country:US
Mailing Address - Phone:781-553-4618
Mailing Address - Fax:617-491-4744
Practice Address - Street 1:59 CHURCH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3724
Practice Address - Country:US
Practice Address - Phone:781-553-4618
Practice Address - Fax:617-491-4744
Is Sole Proprietor?:No
Enumeration Date:2005-08-20
Last Update Date:2008-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA4396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4284Medicare ID - Type UnspecifiedBLUE SHIELD & MEDICARE