Healthcare Provider Details

I. General information

NPI: 1588376891
Provider Name (Legal Business Name): KEANA FAIRFAX MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEANA REED MSW, LCSW

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MONMOUTH ST
GLOUCESTER CITY NJ
08030-1502
US

IV. Provider business mailing address

535 MONMOUTH ST
GLOUCESTER CITY NJ
08030-1502
US

V. Phone/Fax

Practice location:
  • Phone: 609-920-3848
  • Fax:
Mailing address:
  • Phone: 609-920-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06000000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: