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General NPI Number Information
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NPI Number | 1518197276
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Entity Type | Individual
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Provider Name | ERIS KEYNAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1800 COLUMBUS AVE
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City | ROXBURY
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State | MA
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Zip | 02119-1042
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Country | US
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Telephone | 617-442-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 5 SHAW RD
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-3121
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Country | US
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Telephone | 617-323-2673
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2028434
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License Number State | MA
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