=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154661312
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORAH ROSE KEENAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2013
-----------------------------------------------------
Last Update Date | 02/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6912 HARDING HWY
-----------------------------------------------------
City | MAYS LANDING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-829-6645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6912 HARDING HWY
-----------------------------------------------------
City | MAYS LANDING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08330-1031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-829-6645
-----------------------------------------------------
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 | 44SW05288200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------