Provider Demographics
NPI:1952458374
Name:OKEEFE, MARY J (RN LADC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:RN LADC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:96 FRONT STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260
Mailing Address - Country:US
Mailing Address - Phone:860-963-2225
Mailing Address - Fax:860-963-7354
Practice Address - Street 1:96 FRONT STREET
Practice Address - Street 2:SUITE D
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260
Practice Address - Country:US
Practice Address - Phone:860-963-2225
Practice Address - Fax:860-963-7354
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000651 LADC101YA0400X
CTE47816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163W00000XNursing Service ProvidersRegistered Nurse