Provider Demographics
NPI:1780382432
Name:KEERAN, JENNIFER (SW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KEERAN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 KEERAN LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3782
Mailing Address - Country:US
Mailing Address - Phone:505-249-1031
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIA MUNICIPAL SCHOOLS
Practice Address - Street 2:300 NORTH STREET
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016
Practice Address - Country:US
Practice Address - Phone:505-384-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-12341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker