Provider Demographics
NPI:1508283896
Name:KEANE, FREDERICK W (LCSW)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:W
Last Name:KEANE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEMLOCK TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-5764
Mailing Address - Country:US
Mailing Address - Phone:914-714-3178
Mailing Address - Fax:
Practice Address - Street 1:6 HEMLOCK TRAIL CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-5764
Practice Address - Country:US
Practice Address - Phone:914-714-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0790951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical