Provider Demographics
NPI:1205942612
Name:KEELER, ROBIN MURRAY (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:MURRAY
Last Name:KEELER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 FOREST AVE. STE 4A
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3403
Mailing Address - Country:US
Mailing Address - Phone:831-601-7947
Mailing Address - Fax:
Practice Address - Street 1:621 FOREST AVE, 4A
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950
Practice Address - Country:US
Practice Address - Phone:831-372-9268
Practice Address - Fax:831-372-9268
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ84157ZMedicare UPIN