Provider Demographics
NPI:1285972356
Name:KELLER, JAMES E II (JD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:KELLER
Suffix:II
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:989 W KENNEDY BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6199
Mailing Address - Country:US
Mailing Address - Phone:321-263-0590
Mailing Address - Fax:321-263-0597
Practice Address - Street 1:989 W KENNEDY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6199
Practice Address - Country:US
Practice Address - Phone:321-263-0590
Practice Address - Fax:321-263-0597
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker