MEDICARE: MAIREAD KEOGAN

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1821517269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIREAD KEOGAN

Provider Business Mailing Address
First Line	:	61 BEACH 217TH ST
Second Line	:
City	:	BREEZY POINT
State	:	NY
Zip	:	11697-1512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 BEACH CHANNEL DR
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2818
Country	:	US
Telephone Number	:	646-260-7569
Fax Number	:	646-260-7569

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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Directions to “ MAIREAD KEOGAN ” Practice Location

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