Provider Demographics
NPI:1356351597
Name:KEENAN, DAVID H (MSW EDD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:KEENAN
Suffix:
Gender:M
Credentials:MSW EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 NEWTOWN RD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4808
Mailing Address - Country:US
Mailing Address - Phone:757-461-3313
Mailing Address - Fax:757-461-8363
Practice Address - Street 1:6330 NEWTOWN RD
Practice Address - Street 2:SUITE 625
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4808
Practice Address - Country:US
Practice Address - Phone:757-461-3313
Practice Address - Fax:757-461-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist