Provider Demographics
NPI:1912138678
Name:KEATING, LEO D (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:D
Last Name:KEATING
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MILL ST
Mailing Address - Street 2:STE 306
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4744
Mailing Address - Country:US
Mailing Address - Phone:617-899-1572
Mailing Address - Fax:
Practice Address - Street 1:48 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3445
Practice Address - Country:US
Practice Address - Phone:617-899-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical