Healthcare Provider Details

I. General information

NPI: 1114024296
Provider Name (Legal Business Name): JERALDINE S KEANE-DREYER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 TANDBERG TRL SUITE 4
WINDHAM ME
04062-6417
US

IV. Provider business mailing address

PO BOX 96
RAYMOND ME
04071-0096
US

V. Phone/Fax

Practice location:
  • Phone: 207-655-9008
  • Fax: 207-655-9005
Mailing address:
  • Phone: 207-655-9008
  • Fax: 207-655-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY625
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: