Provider Demographics
NPI:1013074541
Name:SMITH, KEAVY HENNESSEY (LCSW)
Entity Type:Individual
Prefix:
First Name:KEAVY
Middle Name:HENNESSEY
Last Name:SMITH
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 1:69 AGNES DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3845
Mailing Address - Country:US
Mailing Address - Phone:617-784-4619
Mailing Address - Fax:
Practice Address - Street 1:25 UNION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1112
Practice Address - Country:US
Practice Address - Phone:617-784-4619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker