Provider Demographics
NPI:1497703748
Name:KEENAN, JOHN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:KEENAN
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 1:23250 CHAGRIN BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5445
Mailing Address - Country:US
Mailing Address - Phone:216-464-4243
Mailing Address - Fax:
Practice Address - Street 1:23250 CHAGRIN BLVD STE 425
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5445
Practice Address - Country:US
Practice Address - Phone:216-464-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 853103T00000X
OHP.08056103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00A0248896OtherHMSA
HI72440163OtherKAISER