Provider Demographics
NPI:1346490463
Name:KEENAN, LUCILLE BAKER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:BAKER
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WOODBURN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1618
Mailing Address - Country:US
Mailing Address - Phone:919-604-7401
Mailing Address - Fax:
Practice Address - Street 1:213 WOODBURN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1618
Practice Address - Country:US
Practice Address - Phone:919-604-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical