Provider Demographics
NPI:1356358824
Name:KELLER, KAREN H (LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:H
Last Name:KELLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3727
Mailing Address - Country:US
Mailing Address - Phone:603-991-4903
Mailing Address - Fax:603-444-5826
Practice Address - Street 1:111 SARANAC ST STE 16
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4031
Practice Address - Country:US
Practice Address - Phone:603-991-4903
Practice Address - Fax:603-444-5826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13251041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1012662Medicaid
NH3094960Medicaid