Provider Demographics
NPI:1013668748
Name:KEENAN, CHRISTOPHER EUGENE SR (LADC, LPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:KEENAN
Suffix:SR
Gender:M
Credentials:LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NEWFANE RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4720
Mailing Address - Country:US
Mailing Address - Phone:475-289-8378
Mailing Address - Fax:
Practice Address - Street 1:19 NEWFANE RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-4720
Practice Address - Country:US
Practice Address - Phone:475-289-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional