Stacey Keane Boden, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5267C-S Issued in AL

Practice address

3458 Neely Rd
MC Guire Afb, NJ 08641-5312

Phone

(866) 377-2778

NPI assigned

Aug 9, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Stacey Ann Keane Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758672000000",
    "number": "1790468569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 VILLINGER AVE",
            "city": "CINNAMINSON",
            "state": "NJ",
            "postal_code": "080772911",
            "telephone_number": "757-289-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3458 NEELY RD",
            "city": "MC GUIRE AFB",
            "state": "NJ",
            "postal_code": "086415312",
            "telephone_number": "866-377-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEN",
        "first_name": "STACEY",
        "middle_name": "KEANE",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-09",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06491300",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "5267C-S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "KEANE",
            "middle_name": "ANN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• 87TH Medgrp-JB McGuire-Dix-Lakehurst
• Amanda Ammentorp, DO
• Jess Barrows, LCSW, LCADC
• Deon Bullard, MSW, LCSW
• Daniel Castiglia, R.PH.
• Frank Casty, MD
• Gia Chawala
• Victor I Eguaibor, LCSW

• Clinical Social Worker in MC Guire Afb, NJ
• Providers in MC Guire Afb, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; 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.