Provider Demographics
NPI:1811696545
Name:KEEN, JENNIFER L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:KEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SEA MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-9726
Mailing Address - Country:US
Mailing Address - Phone:609-404-6505
Mailing Address - Fax:
Practice Address - Street 1:33 SEA MEADOW DR
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-9726
Practice Address - Country:US
Practice Address - Phone:609-404-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040117611041C0700X
NJ44SC057497001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450360685OtherLLC