Provider Demographics
NPI:1467881797
Name:KEAVENY, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KEAVENY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E MAIN ST STE 530
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2431
Mailing Address - Country:US
Mailing Address - Phone:804-648-0169
Mailing Address - Fax:804-649-4069
Practice Address - Street 1:530 E MAIN ST STE 530
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2431
Practice Address - Country:US
Practice Address - Phone:804-648-0169
Practice Address - Fax:804-649-4069
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical