Healthcare Provider Details

I. General information

NPI: 1609183995
Provider Name (Legal Business Name): KEEGAN MARIE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S STATE ST
DOVER DE
19901-4948
US

IV. Provider business mailing address

8264 GANNON CIR
EASTON MD
21601-7122
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-3135
  • Fax:
Mailing address:
  • Phone: 410-200-7694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17722
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001547
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: