Provider Demographics
NPI:1649478579
Name:KEYDEL, CAROL FRIEBOLIN (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:FRIEBOLIN
Last Name:KEYDEL
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:FRIEBOLIN-KEYDEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LCSW
Mailing Address - Street 1:648 CARRIAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6410
Mailing Address - Country:US
Mailing Address - Phone:410-544-0500
Mailing Address - Fax:410-622-4459
Practice Address - Street 1:648 CARRIAGE HILL RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6410
Practice Address - Country:US
Practice Address - Phone:410-544-0500
Practice Address - Fax:410-622-4459
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical