Provider Demographics
NPI:1588395792
Name:KEATING, IVY HILLARY (LMSW)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:HILLARY
Last Name:KEATING
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 1:31 TANNERS DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1118
Mailing Address - Country:US
Mailing Address - Phone:203-858-3643
Mailing Address - Fax:
Practice Address - Street 1:31 TANNERS DR
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-1118
Practice Address - Country:US
Practice Address - Phone:203-858-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical