Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PSY625 | ME |
NPI | 1114024296 |
---|---|
Provider Name | Dr. Jeraldine S Keane-Dreyer |
First Address | Raymond, ME 04071-0096 |
Second Address | Windham, ME 04062-6417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 15/08/2011 |