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General NPI Number Information
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NPI Number | 1043437288
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Entity Type | Individual
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Provider Name | MARY THERESA KEANE LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9810 PATUXENT WOODS DR STE C
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City | COLUMBIA
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State | MD
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Zip | 21046-1595
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Country | US
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Telephone | 410-290-6432
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Fax | 410-290-6604
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Provider Business Mailing Address
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Address Line | 6148 WAITING SPG
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City | COLUMBIA
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State | MD
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Zip | 21045-4044
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Country | US
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Telephone | 410-730-2889
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05924
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License Number State | MD
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