Provider Demographics
NPI:1508589615
Name:KEHOE, ALEX RYAN (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:RYAN
Last Name:KEHOE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MAUREEN DR
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2703
Mailing Address - Country:US
Mailing Address - Phone:631-838-9105
Mailing Address - Fax:
Practice Address - Street 1:28 MAUREEN DR
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2703
Practice Address - Country:US
Practice Address - Phone:631-838-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker