Provider Demographics
NPI:1033585237
Name:KEENE, SONYA
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:KEENE
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 1:469 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1870
Mailing Address - Country:US
Mailing Address - Phone:207-490-6600
Mailing Address - Fax:207-490-6603
Practice Address - Street 1:469 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1870
Practice Address - Country:US
Practice Address - Phone:207-490-6600
Practice Address - Fax:207-490-6603
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical