John Keane IV, LMSW,BA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

402 E Main St
Waterbury Op Adult Services
Waterbury, CT 06702-1701

Phone

(203) 755-1143

Fax

(203) 755-1447

NPI assigned

Oct 3, 2013

Last updated

Jun 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts

Practice roles

Locations

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

• Jkiv, LLC

  • Clinical Social Worker
  • Milford, CT
  • NPI 1952000754
  NPD Authorized official
• Behavioral Health and Wellness Solutions of CT, LLC

  • Clinical Social Worker
  • Hamden, CT
  • NPI 1114479888
  NPD
• Behavioral Health & Wellness, LLC

  • Clinical Social Worker
  • Hamden, CT
  • NPI 1760149447
  NPD (past)

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1679900765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 E MAIN ST",
            "address_2": "4TH FLOOR ADMINISTRATION",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067022310",
            "telephone_number": "203-574-9000",
            "fax_number": "203-574-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E MAIN ST",
            "address_2": "WATERBURY OP ADULT SERVICES",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021701",
            "telephone_number": "203-755-1143",
            "fax_number": "203-755-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEANE",
        "first_name": "JOHN",
        "name_suffix": "IV",
        "credential": "LMSW,BA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-03",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CT",
            "license": "2166",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Navdeep Kaur, DDS
• Nisrine Kawa, MD, MPH
• Yusuf Serdar Kayaer, MD
• Ahmed Kazi, MD
• Magdalena Kazmierczak, M.D.
• Maureen Elizabeth Keaveney
• Katherine Kedzierski, M.D.
• Andrew F. Keene, DMD
• Raeven B Keene
• Andrew Keliar, LCSW

• Clinical Social Worker in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.