Provider Demographics
NPI:1437633740
Name:KEEN, NEIL B
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:B
Last Name:KEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 BELLA GROVE CIR UNIT 304
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2124
Mailing Address - Country:US
Mailing Address - Phone:813-240-2792
Mailing Address - Fax:
Practice Address - Street 1:8340 BELLA GROVE CIR UNIT 304
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2124
Practice Address - Country:US
Practice Address - Phone:813-240-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health