Provider Demographics
NPI:1053746784
Name:KEENAN, PATRICK (NCC, LPC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KEENAN
Suffix:
Gender:M
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3138
Mailing Address - Country:US
Mailing Address - Phone:203-231-1965
Mailing Address - Fax:833-216-0470
Practice Address - Street 1:115 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-3138
Practice Address - Country:US
Practice Address - Phone:203-231-1965
Practice Address - Fax:833-216-0470
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional