Provider Demographics
NPI:1740298751
Name:KECK, MICHELE MARIE WINTER (MS, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MARIE WINTER
Last Name:KECK
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-5210
Mailing Address - Country:US
Mailing Address - Phone:860-367-4506
Mailing Address - Fax:
Practice Address - Street 1:227 DUNHAM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6133
Practice Address - Country:US
Practice Address - Phone:860-848-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CT0083111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor