Provider Demographics
NPI:1790187870
Name:GIBBLE-KEENAN, JOSEPH LIAM (LCSW, CADC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:LIAM
Last Name:GIBBLE-KEENAN
Suffix:
Gender:M
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6801
Mailing Address - Country:US
Mailing Address - Phone:847-946-3602
Mailing Address - Fax:
Practice Address - Street 1:888 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3965
Practice Address - Country:US
Practice Address - Phone:847-895-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30086101YA0400X
IL149.0164941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)