Provider Demographics
NPI:1902969058
Name:KEAVY, PAULA DALE
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DALE
Last Name:KEAVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1515
Mailing Address - Country:US
Mailing Address - Phone:860-235-0652
Mailing Address - Fax:860-440-3021
Practice Address - Street 1:5 SHAWS CV
Practice Address - Street 2:#207
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4974
Practice Address - Country:US
Practice Address - Phone:860-440-3008
Practice Address - Fax:860-440-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical