Provider Demographics
NPI:1043855000
Name:O'KEEFE, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:O'KEEFE
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 1:7746 66TH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-2202
Mailing Address - Country:US
Mailing Address - Phone:646-321-4265
Mailing Address - Fax:
Practice Address - Street 1:7405 METROPOLITAN AVE # 2F
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2636
Practice Address - Country:US
Practice Address - Phone:646-321-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty