Provider Demographics
NPI:1023689197
Name:RADIX-KEANE, SIOBHAN (LCSW)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:RADIX-KEANE
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 1:8770 SW 126TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5227
Mailing Address - Country:US
Mailing Address - Phone:305-905-2650
Mailing Address - Fax:
Practice Address - Street 1:8770 SW 126TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5227
Practice Address - Country:US
Practice Address - Phone:305-905-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW137851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical