Healthcare Provider Details

I. General information

NPI: 1609948033
Provider Name (Legal Business Name): EITHNE KEENAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 UNION ST SUITE 218
NEW BEDFORD MA
02740-5949
US

IV. Provider business mailing address

261 UNION ST SUITE 218
NEW BEDFORD MA
02740-5949
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-2390
  • Fax:
Mailing address:
  • Phone: 508-996-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2723
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: