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General NPI Number Information
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NPI Number | 1063814747
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Entity Type | Organization
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Legal Business Name | DR. CYNTHIA KEERAN, PH.D., INC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 3228 LOS ARBOLES AVE NE STE. 200
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1962
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Country | US
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Telephone | 505-249-1374
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Fax |
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Provider Business Mailing Address
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Address Line | 8830 KEERAN LN NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-3782
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Country | US
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Telephone | 505-249-1374
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CYNTHIA JEAN KEERAN
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Credential | PH.D.
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Telephone | 505-249-1374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 103571
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License Number State | NM
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