Provider Demographics
NPI:1023361763
Name:KEANE, SOFIA MEZA
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:MEZA
Last Name:KEANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4200
Mailing Address - Country:US
Mailing Address - Phone:650-324-4697
Mailing Address - Fax:650-324-4687
Practice Address - Street 1:1323 HOOVER ST
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4200
Practice Address - Country:US
Practice Address - Phone:650-324-4697
Practice Address - Fax:650-324-4687
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist