MEDICARE: KEANY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)	1A-19-204	CA
2	251B00000X	Case Management Agency	MFC38484	CA
3	252Y00000X	Early Intervention Provider Agency
4	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1134458797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEANY ASSOCIATES

Provider Business Mailing Address
First Line	:	8936 S SEPULVEDA BLVD # 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3628
Country	:	US
Telephone Number	:	310-287-0382
Fax Number	:	310-861-5014

Provider Business Practice Location Address
First Line	:	8936 S SEPULVEDA BLVD # 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3628
Country	:	US
Telephone Number	:	310-287-0382
Fax Number	:	310-861-5014

Authorized Official
Title or Position	:	EXECUTIVE/CLINICAL DIRECTOR
Name	:	JENNIFER KEANY
Credential	:	MFT
Telephone Number	:	310-287-0382

Provider Enumeration Date	:	12/10/2009
Last Update Date	:	09/12/2012

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Directions to “KEANY ASSOCIATES ” Practice Location

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