Individual
TARA KEEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
4660 S EASTERN AVE, #104A, LAS VEGAS, NV 89119-6137
(702) 451-7542
(702) 450-4239
Mailing address
12 OAK TER, SUFFERN, NY 10901-5907
(914) 450-5771
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
5439-S
NV
1041C0700X
Clinical Social Worker
Primary
44SC05500200
NY
1041C0700X
Clinical Social Worker
INTERN-IC-569
NV
Other
Enumeration date
11/05/2009
Last updated
03/20/2012
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