Provider Demographics
NPI:1033222492
Name:KEANE, EDWARD C (EDD, PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:KEANE
Suffix:
Gender:M
Credentials:EDD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HUNTINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-5212
Mailing Address - Country:US
Mailing Address - Phone:203-929-1234
Mailing Address - Fax:
Practice Address - Street 1:8 HUNTINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-5212
Practice Address - Country:US
Practice Address - Phone:203-929-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist