Provider Demographics
NPI:1437356854
Name:KEEN, JULIE REBECCA
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:REBECCA
Last Name:KEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 S PANTOPS DR STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8672
Mailing Address - Country:US
Mailing Address - Phone:434-961-2556
Mailing Address - Fax:434-989-2162
Practice Address - Street 1:8814 FARGO RD STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4647
Practice Address - Country:US
Practice Address - Phone:434-989-2162
Practice Address - Fax:434-989-2162
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical