Provider Demographics
NPI:1205299658
Name:KEENE, CORTNEY M (MED, CAS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:M
Last Name:KEENE
Suffix:
Gender:F
Credentials:MED, CAS, BCBA
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 FARMVU DR
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-6001
Mailing Address - Country:US
Mailing Address - Phone:802-698-0200
Mailing Address - Fax:802-698-0199
Practice Address - Street 1:92 FARMVU DR
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-6001
Practice Address - Country:US
Practice Address - Phone:802-698-0200
Practice Address - Fax:802-698-0199
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT11415415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst