Provider Demographics
NPI:1174539902
Name:KEOHAN, JOYCE B (LICSW)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:B
Last Name:KEOHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-3046
Mailing Address - Country:US
Mailing Address - Phone:781-585-9300
Mailing Address - Fax:781-585-9302
Practice Address - Street 1:62 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-3046
Practice Address - Country:US
Practice Address - Phone:781-585-9300
Practice Address - Fax:781-585-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1059021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA228395OtherMHN/CHAMPUS
MA800012152OtherRAILROAD MEDICARE
MA164420000OtherMAGELLAN
MA2099770OtherCIGNA
MA426056OtherHARVARD/PILGRIM
MAPO44O8OtherBLUE CROSS
MA426056OtherHARVARD/PILGRIM