Provider Demographics
NPI:1730796293
Name:FRED KEANE LCSW, PLLC
Entity type:Organization
Organization Name:FRED KEANE LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KASWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-849-1958
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-8071
Mailing Address - Country:US
Mailing Address - Phone:845-849-1958
Mailing Address - Fax:914-714-3178
Practice Address - Street 1:6 HEMLOCK TRAIL CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-5764
Practice Address - Country:US
Practice Address - Phone:914-714-3178
Practice Address - Fax:888-972-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty