Provider Demographics
NPI:1861676926
Name:KEOHANE, PATRICIA MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:KEOHANE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1003
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-1003
Mailing Address - Country:US
Mailing Address - Phone:508-627-2843
Mailing Address - Fax:508-693-2198
Practice Address - Street 1:15 CHURCH ST
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5483
Practice Address - Country:US
Practice Address - Phone:508-627-2843
Practice Address - Fax:508-693-2198
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health