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General NPI Number Information
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NPI Number | 1154579456
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Entity Type | Organization
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Legal Business Name | MAUREEN M. KEOWN, PSY.D., PC
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 1115 UPPER HEMBREE RD SUITE B
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City | ROSWELL
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State | GA
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Zip | 30076-0913
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Country | US
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Telephone | 770-346-9914
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Fax | 770-475-1171
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Provider Business Mailing Address
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Address Line | 1115 UPPER HEMBREE RD SUITE B
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City | ROSWELL
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State | GA
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Zip | 30076-0913
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Country | US
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Telephone | 770-346-9914
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. MAUREEN M. KEOWN
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Credential | PSY.D.
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Telephone | 770-346-9914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002905
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License Number State | GA
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