Active NPI
Elizabeth Allen Keathley, PH.D.
- Clinical Psychologist
- Middlebury, VT
National Provider Identifier
1407973324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 819
- Practice address
- 64 Main St
Middlebury, VT 05753-1426 - Phone
- (802) 388-3090
- NPI assigned
- Mar 24, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 819 | VT | Primary |
Addresses
Primary practice location
64 Main St
Middlebury, VT 05753-1426
Mailing address
PO Box 813
Middlebury, VT 05753-0813
Phone (802) 388-3090
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1010022 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140709000958 | VT | Practitioner - Clinical Psychologist | 6305061276 | Practice locations: Middlebury, VT |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
36 Main St
FL 2
Middlebury, VT 05753-1416
Phone (802) 388-3090
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 819 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407973324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 813",
"city": "MIDDLEBURY",
"state": "VT",
"postal_code": "057530813",
"telephone_number": "802-388-3090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "64 MAIN ST",
"city": "MIDDLEBURY",
"state": "VT",
"postal_code": "057531426",
"telephone_number": "802-388-3090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEATHLEY",
"first_name": "ELIZABETH",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "819",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1010022",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middlebury, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.