Healthcare Provider Details

I. General information

NPI: 1548255607
Provider Name (Legal Business Name): DANA R KEENER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5636 BOSSLER RD
ELIZABETHTOWN PA
17022-8710
US

IV. Provider business mailing address

245 COFFEE GOSS RD
MARIETTA PA
17547-9203
US

V. Phone/Fax

Practice location:
  • Phone: 717-367-9148
  • Fax: 717-367-9148
Mailing address:
  • Phone: 717-367-9148
  • Fax: 717-367-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005285-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005285-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: