Provider Demographics
NPI:1477521060
Name:KEEFE, DANIEL ARTHUR (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ARTHUR
Last Name:KEEFE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 HENNEPIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2605
Mailing Address - Country:US
Mailing Address - Phone:612-374-9077
Mailing Address - Fax:612-374-3323
Practice Address - Street 1:2431 HENNEPIN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2605
Practice Address - Country:US
Practice Address - Phone:612-374-9077
Practice Address - Fax:612-374-3323
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN015851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R68662Medicare UPIN