Provider Demographics
NPI:1083441919
Name:JONES, KEENAN TAYLOR (LMSW)
Entity type:Individual
Prefix:
First Name:KEENAN
Middle Name:TAYLOR
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12481-0285
Mailing Address - Country:US
Mailing Address - Phone:845-594-4966
Mailing Address - Fax:
Practice Address - Street 1:70 HARRY WELLS RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3816
Practice Address - Country:US
Practice Address - Phone:845-247-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1172171041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool