Provider Demographics
NPI:1699247924
Name:KEEFE, MADELYN DREW JOHNSTONE (LICSW)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:DREW JOHNSTONE
Last Name:KEEFE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 BENNETT PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4113
Mailing Address - Country:US
Mailing Address - Phone:908-370-4573
Mailing Address - Fax:
Practice Address - Street 1:3634 WRIGHT TER NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3847
Practice Address - Country:US
Practice Address - Phone:202-949-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500816831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC7568834Medicaid