Provider Demographics
NPI:1285915843
Name:KEOGH, JOHN TAYLOR (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TAYLOR
Last Name:KEOGH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NEW CHARDON ST
Mailing Address - Street 2:JUVENILE COURT CLINIC
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4703
Mailing Address - Country:US
Mailing Address - Phone:617-788-6707
Mailing Address - Fax:
Practice Address - Street 1:24 NEW CHARDON ST
Practice Address - Street 2:JUVENILE COURT CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-788-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist