Provider Demographics
NPI:1902323744
Name:O'KEEFE, SPENCER (LPC)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6014
Mailing Address - Country:US
Mailing Address - Phone:203-631-5597
Mailing Address - Fax:
Practice Address - Street 1:107 HORTON AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6014
Practice Address - Country:US
Practice Address - Phone:203-631-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008068631Medicaid
CT008068669Medicaid
CT008075035Medicaid