Provider Demographics
NPI:1750030102
Name:KEAN, OLIVIA (LMSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6068 PLUMAS ST APT H
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-6034
Mailing Address - Country:US
Mailing Address - Phone:707-292-5390
Mailing Address - Fax:
Practice Address - Street 1:860 TYLER WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2172
Practice Address - Country:US
Practice Address - Phone:775-356-0371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9679-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker