Provider Demographics
NPI:1205854973
Name:KEANE, TERENCE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:M
Last Name:KEANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:RESEARCH SERVICE (151)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-4551
Mailing Address - Fax:857-364-4486
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:RESEARCH SERVICE (151)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4551
Practice Address - Fax:857-364-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3847103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical