Provider Demographics
NPI:1801113345
Name:TEEMSMA, O. KEELEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:O. KEELEY
Middle Name:
Last Name:TEEMSMA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KEELEY
Other - Middle Name:
Other - Last Name:TEEMSMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:9281 SHORE RD APT 227
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6613
Mailing Address - Country:US
Mailing Address - Phone:646-685-4499
Mailing Address - Fax:516-218-7964
Practice Address - Street 1:159 20TH ST STE 1B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:646-685-4499
Practice Address - Fax:516-218-7964
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0816441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty