Provider Demographics
NPI:1174277933
Name:KEATING, KEVIN (LMHC, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:KEATING
Suffix:
Gender:M
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18459 PINES BLVD # 153
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:954-854-1902
Mailing Address - Fax:
Practice Address - Street 1:2121 HARBOR WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2345
Practice Address - Country:US
Practice Address - Phone:954-854-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health