Provider Demographics
NPI:1891187019
Name:KEOHAN, ELIZABETH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KEOHAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 W REGENTS PARK RD
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2525
Mailing Address - Country:US
Mailing Address - Phone:202-375-9817
Mailing Address - Fax:
Practice Address - Street 1:1763 W REGENTS PARK RD
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2525
Practice Address - Country:US
Practice Address - Phone:202-375-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical