=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548784911
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN HOLMES KEENAN MSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2017
-----------------------------------------------------
Last Update Date | 07/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 183 COLUMBIA RD
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02339-2388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 339-526-0047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91 ABERDEEN DR
-----------------------------------------------------
City | SCITUATE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02066-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-728-6197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 115407
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------