Provider Demographics
NPI:1679257851
Name:KEADY, JANE (LMSW/LGSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KEADY
Suffix:
Gender:F
Credentials:LMSW/LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N UNION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2643
Mailing Address - Country:US
Mailing Address - Phone:703-718-6844
Mailing Address - Fax:877-447-1027
Practice Address - Street 1:211 N UNION ST STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2643
Practice Address - Country:US
Practice Address - Phone:703-718-6844
Practice Address - Fax:877-447-1027
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002858104100000X
VA0903004349104100000X
MD32173104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker