Individual
DR. MARK H. KEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
687 HIGHLAND AVE, NEEDHAM, MA 02494-2232
(617) 254-3800
(617) 779-1482
Mailing address
259 ROCK ST APT A10, NORWOOD, MA 02062-4977
(781) 769-9689
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
7092
MA
103TC0700X
Clinical Psychologist
7092
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0500054
—
MA
05
—
110022270A
—
MA
01
—
W06000
BLUE CROSS-BLUE SHIELD
MA
Enumeration date
01/02/2007
Last updated
03/11/2019
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