Provider Demographics
NPI:1548255607
Name:KEENER, DANA R (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:R
Last Name:KEENER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COFFEE GOSS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-9203
Mailing Address - Country:US
Mailing Address - Phone:717-367-9148
Mailing Address - Fax:717-367-9148
Practice Address - Street 1:5636 BOSSLER RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-8710
Practice Address - Country:US
Practice Address - Phone:717-367-9148
Practice Address - Fax:717-367-9148
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005285-L103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE650482OtherBLUE CROSS - BLUE SHIELD
PA007153843 0002OtherMEDICAL ASSISTANCE PROVID
PA650482Medicare ID - Type Unspecified