Active NPI
Theresa A Keane, LCSW-R
- Clinical Social Worker
- Smithtown, NY
National Provider Identifier
1104382969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- RO52037-1
- Practice address
- 285 Middle Country Rd # LL5
Smithtown, NY 11787-2978 - Phone
- (631) 724-0600
- NPI assigned
- Feb 18, 2019
- 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 | RO52037-1 | NY | Primary |
Addresses
Primary practice location
285 Middle Country Rd # LL5
Smithtown, NY 11787-2978
Mailing address
285 Middle Country Rd # LL5
Smithtown, NY 11787-2978
Phone (631) 724-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 18, 2024 through Oct 18, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RO52037-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550448000000",
"number": "1104382969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "285 MIDDLE COUNTRY RD # LL5",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872978",
"telephone_number": "631-724-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "285 MIDDLE COUNTRY RD # LL5",
"city": "SMITHTOWN",
"state": "NY",
"postal_code": "117872978",
"telephone_number": "631-724-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEANE",
"first_name": "THERESA",
"middle_name": "A",
"credential": "LCSW-R",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-18",
"last_updated": "2019-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "RO52037-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Smithtown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.