Healthcare Provider Details

I. General information

NPI: 1134458797
Provider Name (Legal Business Name): KEANY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 S SEPULVEDA BLVD # 200
LOS ANGELES CA
90045-3628
US

IV. Provider business mailing address

8936 S SEPULVEDA BLVD # 200
LOS ANGELES CA
90045-3628
US

V. Phone/Fax

Practice location:
  • Phone: 310-287-0382
  • Fax: 310-861-5014
Mailing address:
  • Phone: 310-287-0382
  • Fax: 310-861-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMFC38484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1A-19-204
License Number StateCA

VIII. Authorized Official

Name: JENNIFER KEANY
Title or Position: EXECUTIVE/CLINICAL DIRECTOR
Credential: MFT
Phone: 310-287-0382