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NPI Code Detail

MEDICARE: KELSEY SHAWN KEANE

MEDICARE: KELSEY SHAWN KEANE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker103044CA

General Provider Information

NPI Number : 1174017131
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY SHAWN KEANE
Provider Business Mailing Address
First Line : 770 53RD ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 770 53RD ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1814
Country : US
Telephone Number : 510-428-8428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 01/20/2026

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Directions to “ KELSEY SHAWN KEANE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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