MEDICARE: MS. O. KEELEY TEEMSMA LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1801113345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. O. KEELEY TEEMSMA LCSW

Provider Business Mailing Address
First Line	:	9281 SHORE RD APT 227
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-6613
Country	:	US
Telephone Number	:	646-685-4499
Fax Number	:	516-218-7964

Provider Business Practice Location Address
First Line	:	159 20TH ST STE 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11232
Country	:	US
Telephone Number	:	646-685-4499
Fax Number	:	516-218-7964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	01/20/2022

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