Provider Demographics
NPI:1851686976
Name:KEANE, ELIZABETH J (MED)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KEANE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2945
Mailing Address - Country:US
Mailing Address - Phone:978-505-8165
Mailing Address - Fax:
Practice Address - Street 1:54 WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2945
Practice Address - Country:US
Practice Address - Phone:978-505-8165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist