Healthcare Provider Details

I. General information

NPI: 1508283896
Provider Name (Legal Business Name): FREDERICK W. KEANE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FORT HILL RD STE A402
PEEKSKILL NY
10566-2264
US

IV. Provider business mailing address

200 FORT HILL RD STE A402
PEEKSKILL NY
10566-2264
US

V. Phone/Fax

Practice location:
  • Phone: 914-714-3178
  • Fax:
Mailing address:
  • Phone: 914-714-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: