Provider Demographics
NPI:1124581178
Name:PATRICK M. KEENAN, PLLC
Entity Type:Organization
Organization Name:PATRICK M. KEENAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC
Authorized Official - Phone:203-828-8602
Mailing Address - Street 1:115 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3138
Mailing Address - Country:US
Mailing Address - Phone:203-828-8602
Mailing Address - Fax:833-216-0470
Practice Address - Street 1:115 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3138
Practice Address - Country:US
Practice Address - Phone:203-828-8602
Practice Address - Fax:833-216-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty