Provider Demographics
NPI:1386774651
Name:KEENE, CYNTHIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:KEENE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E OGDEN AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8609
Mailing Address - Country:US
Mailing Address - Phone:630-690-9589
Mailing Address - Fax:
Practice Address - Street 1:1020 E OGDEN AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8609
Practice Address - Country:US
Practice Address - Phone:630-690-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.003174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist