=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134458797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEANY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2009
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8936 S SEPULVEDA BLVD # 200
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-287-0382
-----------------------------------------------------
Fax | 310-861-5014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8936 S SEPULVEDA BLVD # 200
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90045-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-287-0382
-----------------------------------------------------
Fax | 310-861-5014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE/CLINICAL DIRECTOR
-----------------------------------------------------
Name | JENNIFER KEANY
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 310-287-0382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number | 1A-19-204
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | MFC38484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------