Provider Demographics
NPI:1487790622
Name:KEELAN, RICHARD E (MA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:KEELAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3237
Mailing Address - Country:US
Mailing Address - Phone:978-353-3177
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3876
Practice Address - Country:US
Practice Address - Phone:508-849-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor