Provider Demographics
NPI:1649329897
Name:KEEFE, KRISTEN L (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:KEEFE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1919
Mailing Address - Country:US
Mailing Address - Phone:508-497-5154
Mailing Address - Fax:617-244-4906
Practice Address - Street 1:425 WATERTOWN ST
Practice Address - Street 2:THE ACADEMY OF PHYSICAL AND SOCIAL DEVELOPMENT
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1131
Practice Address - Country:US
Practice Address - Phone:617-257-1581
Practice Address - Fax:617-244-4906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0761OtherBCBS PROVIDER NUMBER