Healthcare Provider Details

I. General information

NPI: 1932056801
Provider Name (Legal Business Name): DR. KEEBA GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111B S GOVERNORS AVE STE 26881
DOVER DE
19904-6903
US

IV. Provider business mailing address

703 WASHINGTON AVE
TOWSON MD
21204-3927
US

V. Phone/Fax

Practice location:
  • Phone: 240-454-5538
  • Fax:
Mailing address:
  • Phone: 240-454-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07681
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: