Provider Demographics
NPI:1851844021
Name:KELLER, DOUGLAS
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:KELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SPRINGDALE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2763
Mailing Address - Country:US
Mailing Address - Phone:609-304-7754
Mailing Address - Fax:856-424-7384
Practice Address - Street 1:1301 SPRINGDALE RD STE 150
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2763
Practice Address - Country:US
Practice Address - Phone:609-424-1333
Practice Address - Fax:856-424-7384
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07179100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker