Individual provider Active NPI

Tara Keegan, MSW, LCSW

  • Clinical Social Worker
  • Las Vegas, NV
National Provider Identifier
1578890919
Registry record updated Mar 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05500200 Issued in NY
Practice address
4660 S Eastern Ave
#104A
Las Vegas, NV 89119-6137
Phone
(702) 451-7542
Fax
(702) 450-4239
NPI assigned
Nov 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05500200 NY Primary
Social Worker 104100000X 5439-S NV
Clinical Social Worker 1041C0700X INTERN-IC-569 NV

Addresses

Primary practice location

4660 S Eastern Ave
#104A
Las Vegas, NV 89119-6137

Mailing address

12 Oak Ter
Suffern, NY 10901-5907
Phone (914) 450-5771

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5439-SNVMDSocial Worker
INTERN-IC-569NVMDClinical Social Worker
44SC05500200NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Bilingual Behavioral Services Past Accepting new patients
Mente Sana Education Provention Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332201600000",
    "number": "1578890919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 OAK TER",
            "city": "SUFFERN",
            "state": "NY",
            "postal_code": "109015907",
            "telephone_number": "914-450-5771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 S EASTERN AVE",
            "address_2": "#104A",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196137",
            "telephone_number": "702-451-7542",
            "fax_number": "702-450-4239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEEGAN",
        "first_name": "TARA",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2012-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "44SC05500200",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NV",
            "license": "5439-S",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "INTERN-IC-569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.