Provider Demographics
NPI:1649481664
Name:KEAVENEY, JOANNE (RD)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:KEAVENEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-3735
Mailing Address - Country:US
Mailing Address - Phone:781-251-9646
Mailing Address - Fax:
Practice Address - Street 1:99 TURNER ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-3735
Practice Address - Country:US
Practice Address - Phone:781-251-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANU 418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered