Provider Demographics
| NPI: | 1497847156 |
|---|---|
| Name: | KEENAN, CYNTHIA A (PHD LCMHC) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | CYNTHIA |
| Middle Name: | A |
| Last Name: | KEENAN |
| Suffix: | |
| Gender: | F |
| Credentials: | PHD LCMHC |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 31 RAYNES AVE |
| Mailing Address - Street 2: | SUITE # 200 |
| Mailing Address - City: | PORTSMOUTH |
| Mailing Address - State: | NH |
| Mailing Address - Zip Code: | 03801-3756 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 603-433-6777 |
| Mailing Address - Fax: | 603-433-6778 |
| Practice Address - Street 1: | 31 RAYNES AVE |
| Practice Address - Street 2: | SUITE # 200 |
| Practice Address - City: | PORTSMOUTH |
| Practice Address - State: | NH |
| Practice Address - Zip Code: | 03801-3756 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 603-433-6777 |
| Practice Address - Fax: | 603-433-6778 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2006-09-29 |
| Last Update Date: | 2008-09-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NH | 435 | 101YM0800X |
| NH | 79885 | 103TS0200X |
| 103T00000X, 103TA0400X, 103TA0700X, 103TC2200X, 103TB0200X, 103TF0000X, 103TP2701X, 103TM1800X, 103G00000X, 101YA0400X, 101YP2500X, 106H00000X, 103TC1900X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NH | 11626483 | Other | CAQH PROVIDER ID |
