Active NPI
Laura Keanon, LCSW-C
- Clinical Social Worker
- Silver Spring, MD
National Provider Identifier
1063565638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 01142
- Practice address
- 2012 Hanover St
Silver Spring, MD 20910-2105 - Phone
- (301) 585-8075
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 01142 | MD | Primary |
Addresses
Primary practice location
2012 Hanover St
Silver Spring, MD 20910-2105
Mailing address
2012 Hanover St
Silver Spring, MD 20910-2105
Phone (301) 585-8075
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 642476 | Other | MD | MEDICARE PTAN |
Other names 1
- Laura Boldrick
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01142 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1063565638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 HANOVER ST",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209102105",
"telephone_number": "301-585-8075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 HANOVER ST",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209102105",
"telephone_number": "301-585-8075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEANON",
"first_name": "LAURA",
"credential": "LCSW-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "01142",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "642476",
"state": "MD"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LAURA",
"last_name": "BOLDRICK",
"credential": "LCSW-C",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Silver Spring, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.