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General NPI Number Information
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NPI Number | 1992417018
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Entity Type | Organization
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Legal Business Name | KEYSTONE HEALTHCARE SYSTEMS LLC
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 105 WEBSTER ST STE 5
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City | HANOVER
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State | MA
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Zip | 02339-1227
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Country | US
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Telephone | 901-264-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 75 PARKVIEW ST APT 207
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City | WEYMOUTH
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State | MA
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Zip | 02190-3932
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Country | US
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Telephone | 617-468-6426
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALEB SOLOMON BROOKS
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Credential | LCSW
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Telephone | 617-468-6426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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