Provider Demographics
NPI:1962983841
Name:KEOHANE, STEPHEN FIELD (PHD, MSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FIELD
Last Name:KEOHANE
Suffix:
Gender:M
Credentials:PHD, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 FREEDOM LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4132
Mailing Address - Country:US
Mailing Address - Phone:865-940-1032
Mailing Address - Fax:
Practice Address - Street 1:331 FREEDOM LN
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4132
Practice Address - Country:US
Practice Address - Phone:865-940-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10262541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical