Provider Demographics
NPI:1760841639
Name:ROBERTSONAGGERS, KEEGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:
Last Name:ROBERTSONAGGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BROCK ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23690-3407
Mailing Address - Country:US
Mailing Address - Phone:603-422-3260
Mailing Address - Fax:
Practice Address - Street 1:VETERANS HEALTH ADMINISTRATION
Practice Address - Street 2:100 EMANCIPATION DRIVE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1191401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical