Provider Demographics
NPI:1356039721
Name:KEELEY PSYCHIATRY OF SOUTH CAROLINA, LLC
Entity type:Organization
Organization Name:KEELEY PSYCHIATRY OF SOUTH CAROLINA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:240-877-9865
Mailing Address - Street 1:405 S PINE ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2742
Mailing Address - Country:US
Mailing Address - Phone:240-877-9865
Mailing Address - Fax:240-201-3033
Practice Address - Street 1:405 S PINE ST STE E
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2742
Practice Address - Country:US
Practice Address - Phone:642-024-7978
Practice Address - Fax:240-201-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty