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General NPI Number Information
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NPI Number | 1811191414
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Entity Type | Individual
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Provider Name | THERESA KEANE PH.D., NPP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 7750 E BROADWAY BLVD STE A100
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City | TUCSON
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State | AZ
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Zip | 85710-3901
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Country | US
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Telephone | 520-327-1529
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Fax |
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Provider Business Mailing Address
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Address Line | 97 GRACE WAY
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City | OLIVEBRIDGE
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State | NY
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Zip | 12461-5236
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Country | US
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Telephone | 917-453-3684
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Fax | 917-453-3684
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 011974-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401198
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License Number State | NY
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