Provider Demographics
NPI:1023769338
Name:KEELER, ELEANOR DENISE
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:DENISE
Last Name:KEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-7044
Mailing Address - Country:US
Mailing Address - Phone:802-760-8935
Mailing Address - Fax:
Practice Address - Street 1:370 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-7044
Practice Address - Country:US
Practice Address - Phone:802-760-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty