Provider Demographics
NPI:1720724917
Name:KEAVENY, BRIANA RENEE
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:RENEE
Last Name:KEAVENY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRIANA
Other - Middle Name:RENEE
Other - Last Name:KOZIANOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3019 MONTEZUMA ST APT C
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-7923
Mailing Address - Country:US
Mailing Address - Phone:586-909-2090
Mailing Address - Fax:
Practice Address - Street 1:1105 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5358
Practice Address - Country:US
Practice Address - Phone:843-379-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-24-377278106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician