Healthcare Provider Details

I. General information

NPI: 1104231786
Provider Name (Legal Business Name): CINDY JEAN KEERAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 LOS ARBOLES AVE NE BLDG. A. SUITE 200
ALBUQUERQUE NM
87107-1962
US

IV. Provider business mailing address

8830 KEERAN LN NE
ALBUQUERQUE NM
87122-3782
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-1374
  • Fax:
Mailing address:
  • Phone: 505-249-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number103571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: