Provider Demographics
NPI:1548286479
Name:KEELER, CAROL C (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:C
Last Name:KEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E NEW ENGLAND AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4346
Mailing Address - Country:US
Mailing Address - Phone:407-629-5244
Mailing Address - Fax:407-699-9429
Practice Address - Street 1:157 E NEW ENGLAND AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4346
Practice Address - Country:US
Practice Address - Phone:407-629-5244
Practice Address - Fax:407-699-9429
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW13061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067117OtherVALUE OPTIONS
FL62-39813OtherUNITED BEHAVIORAL HEALTH
FL7328420OtherUNITED HEALTH CARE
FLA140685OtherMAGELLAN
FL4203167OtherAETNA
FL593048590327890000OtherCHAMPUS/TRICARE
FLZ1666Medicare ID - Type UnspecifiedMEDICARE