Provider Demographics
NPI:1518578145
Name:KEEFE, CHRISTINA MARIE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:BIG PINE
Mailing Address - State:CA
Mailing Address - Zip Code:93513-2002
Mailing Address - Country:US
Mailing Address - Phone:510-789-9607
Mailing Address - Fax:
Practice Address - Street 1:222 TERRACE DR
Practice Address - Street 2:
Practice Address - City:BIG PINE
Practice Address - State:CA
Practice Address - Zip Code:93513-2002
Practice Address - Country:US
Practice Address - Phone:510-789-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2734103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool