MEDICARE: TRINITY KEENAN 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	DP00943183	WV

General Provider Information

NPI Number	:	1962868158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINITY KEENAN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 131
Second Line	:
City	:	MOUNT CARBON
State	:	WV
Zip	:	25139-0131
Country	:	US
Telephone Number	:	304-553-9796
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WASHINGTON ST E # A
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1766
Country	:	US
Telephone Number	:	304-837-2243
Fax Number	:	304-510-4778

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	02/08/2026

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Directions to “ TRINITY KEENAN LCSW” Practice Location

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