Provider Demographics
NPI:1205622347
Name:KELLER, GEOFFREY THEODORE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:THEODORE
Last Name:KELLER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WINGATE CT
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5408
Mailing Address - Country:US
Mailing Address - Phone:412-508-7579
Mailing Address - Fax:
Practice Address - Street 1:14 MAINE ST STE 309
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2033
Practice Address - Country:US
Practice Address - Phone:207-607-4022
Practice Address - Fax:207-607-4048
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist