Doctor Name: | KEELIN THERESE CARROCIA |
NPI Number: | 1295160505 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CT |
License Number: | |
Business Practice Address: | 5706 Turney Rd Suite 200 Garfield Heights, OH - 441253971 |
Business Phone Number: | 4402608584 |
Business Fax Number: | |
Mailing Address: | 17700 Fairway Dr, Apt 302 CLEVELAND |
State: | OH |
Postal Code: | 441351885 |
Phone Number: | 2169030147 |
Fax Number: | |
NPI Enumeration Date: | 09/05/2013 |
NPI Last Update Date: | 10/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |