=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023534765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET KEATING LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2017
-----------------------------------------------------
Last Update Date | 08/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 COPPERTREE LN
-----------------------------------------------------
City | BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11702-3812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-807-5329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 COPPERTREE LN
-----------------------------------------------------
City | BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11702-3812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 075284
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------