Provider Demographics
NPI:1033141403
Name:KEEFE, MARY A (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-2778
Mailing Address - Country:US
Mailing Address - Phone:603-882-4410
Mailing Address - Fax:603-882-1891
Practice Address - Street 1:39 SIMON ST STE 13
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-882-4410
Practice Address - Fax:603-882-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025551041C0700X
NH1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23564Medicare ID - Type UnspecifiedMEDICARE PROVIDER, MA
NHRE 3098Medicare ID - Type UnspecifiedMEDICARE PROVIDER