Provider Demographics
NPI:1780133447
Name:KEEVY, MADELEINE DIANE (BCBA-D)
Entity type:Individual
Prefix:
First Name:MADELEINE
Middle Name:DIANE
Last Name:KEEVY
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:DIANE
Other - Last Name:MILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 TIMBER CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4396
Mailing Address - Country:US
Mailing Address - Phone:901-410-3595
Mailing Address - Fax:
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4396
Practice Address - Country:US
Practice Address - Phone:901-410-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst