Provider Demographics
NPI:1760739551
Name:KEEN, SARA T (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:T
Last Name:KEEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1362 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8902
Mailing Address - Country:US
Mailing Address - Phone:386-871-9632
Mailing Address - Fax:386-200-4410
Practice Address - Street 1:1362 N US HIGHWAY 1
Practice Address - Street 2:SUITE 301
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8902
Practice Address - Country:US
Practice Address - Phone:386-871-9632
Practice Address - Fax:386-200-4410
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health