Provider Demographics
NPI:1881748606
Name:KEEFE, KARRALYNN JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:KARRALYNN
Middle Name:JENNIFER
Last Name:KEEFE
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 1:1356 RIDGERUN DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-7650
Mailing Address - Country:US
Mailing Address - Phone:916-580-3231
Mailing Address - Fax:916-734-0561
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:SUITE 3200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-8292
Practice Address - Fax:916-734-0561
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 191111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10212OtherCALIFORNIA CHILDREN'S SER