Provider Demographics
NPI:1508199639
Name:KEELER, WINTER FAULCONBRIDGE (LICSW, MSW, CTRI)
Entity Type:Individual
Prefix:
First Name:WINTER
Middle Name:FAULCONBRIDGE
Last Name:KEELER
Suffix:
Gender:F
Credentials:LICSW, MSW, CTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HENNIKER ST # 131
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03244-5523
Mailing Address - Country:US
Mailing Address - Phone:978-252-0709
Mailing Address - Fax:603-680-4420
Practice Address - Street 1:4 AIKEN STREET
Practice Address - Street 2:
Practice Address - City:ANTRIM
Practice Address - State:NH
Practice Address - Zip Code:03440
Practice Address - Country:US
Practice Address - Phone:978-252-0709
Practice Address - Fax:603-680-4420
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20301041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health