Healthcare Provider Details

I. General information

NPI: 1912136177
Provider Name (Legal Business Name): MR. ROBERT EDWARD O'KEEFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 FLIRTATION AVE
NEW PRESTON CT
06777-1709
US

IV. Provider business mailing address

31 FLIRTATION AVENUE
NEW PRESTON CT
06777
US

V. Phone/Fax

Practice location:
  • Phone: 860-868-2868
  • Fax:
Mailing address:
  • Phone: 860-868-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number001605
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: