Provider Demographics
NPI:1609277250
Name:KEANE, KATHRYN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LEXINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1921
Mailing Address - Country:US
Mailing Address - Phone:978-490-3314
Mailing Address - Fax:978-791-4013
Practice Address - Street 1:450 LEXINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1921
Practice Address - Country:US
Practice Address - Phone:978-490-3314
Practice Address - Fax:978-791-4013
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1222801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical