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NPI Code Detail

MEDICARE: JENNIFER KEANY MFT

MEDICARE:   JENNIFER  KEANY  MFT
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
1106H00000XMarriage & Family TherapistMFC38484CA

General Provider Information

NPI Number : 1205260379
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KEANY MFT
Provider Business Mailing Address
First Line : 8936 S SEPULVEDA BLVD
Second Line : SUITE 200
City : LOS ANGELES
State : CA
Zip : 90045-3628
Country : US
Telephone Number : 310-590-2851
Fax Number :
Provider Business Practice Location Address
First Line : 8936 S SEPULVEDA BLVD
Second Line : SUITE 200
City : LOS ANGELES
State : CA
Zip : 90045-3628
Country : US
Telephone Number : 310-590-2851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2013
Last Update Date : 08/26/2013

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Directions to “ JENNIFER KEANY MFT” Practice Location

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