Provider Demographics
NPI:1588132351
Name:KEANS, SOVIN (APCC, RADT)
Entity type:Individual
Prefix:DR
First Name:SOVIN
Middle Name:
Last Name:KEANS
Suffix:
Gender:F
Credentials:APCC, RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 GEARY BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1633
Mailing Address - Country:US
Mailing Address - Phone:415-601-5542
Mailing Address - Fax:
Practice Address - Street 1:13 PETER BEHR DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5216
Practice Address - Country:US
Practice Address - Phone:415-499-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1408301020101YA0400X
CA111659101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA111659OtherBOARD OF BEHAVIORAL SCIENCES