Provider Demographics
NPI:1457048761
Name:KELLER, CARSEN DANIELLE
Entity type:Individual
Prefix:
First Name:CARSEN
Middle Name:DANIELLE
Last Name:KELLER
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 1:304 S STONESTREET AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4149
Mailing Address - Country:US
Mailing Address - Phone:816-672-9430
Mailing Address - Fax:
Practice Address - Street 1:304 S STONESTREET AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4149
Practice Address - Country:US
Practice Address - Phone:816-672-9430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician