Healthcare Provider Details

I. General information

NPI: 1881708147
Provider Name (Legal Business Name): JAMES O'KEEFE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SPRING STREET
TIVOLI NY
12583
US

IV. Provider business mailing address

PO BOX 314
TIVOLI NY
12583-0314
US

V. Phone/Fax

Practice location:
  • Phone: 845-757-5434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR033495-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: