Provider Demographics
NPI:1134418429
Name:COFIELD, KEENAN KESTER (MPH/PHD/JD)
Entity type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:KESTER
Last Name:COFIELD
Suffix:
Gender:M
Credentials:MPH/PHD/JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 TWINCREST CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3550
Mailing Address - Country:US
Mailing Address - Phone:443-447-8329
Mailing Address - Fax:410-663-5905
Practice Address - Street 1:2126 PITNEY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4924
Practice Address - Country:US
Practice Address - Phone:443-447-8329
Practice Address - Fax:410-663-5905
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral