Healthcare Provider Details

I. General information

NPI: 1215967450
Provider Name (Legal Business Name): JULIE ELIZABETH KEAVENEY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 LANCASTER AVE STE 110
BERWYN PA
19312-1341
US

IV. Provider business mailing address

1199 LANCASTER AVE STE 110
BERWYN PA
19312-1341
US

V. Phone/Fax

Practice location:
  • Phone: 610-241-4331
  • Fax:
Mailing address:
  • Phone: 610-241-4331
  • Fax: 484-416-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS009044L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: