Provider Demographics
NPI:1093301194
Name:O'KEEFE, KELLY NICOLE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1240
Mailing Address - Country:US
Mailing Address - Phone:203-568-6190
Mailing Address - Fax:475-689-2281
Practice Address - Street 1:1 WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4368
Practice Address - Country:US
Practice Address - Phone:203-336-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist