Healthcare Provider Details

I. General information

NPI: 1861328841
Provider Name (Legal Business Name): KAYLA KEEGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 CHURCH ST
NEW BEDFORD MA
02745-1400
US

IV. Provider business mailing address

110 8TH ST APT 2A
NEW BEDFORD MA
02740-6000
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3154
  • Fax:
Mailing address:
  • Phone: 508-404-4597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2142994
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: