Provider Demographics
NPI:1083638068
Name:MULLER, KEITH DEWITT (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:DEWITT
Last Name:MULLER
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1361 S OCEAN BLVD
Mailing Address - Street 2:#602
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7146
Mailing Address - Country:US
Mailing Address - Phone:954-464-3319
Mailing Address - Fax:954-776-7160
Practice Address - Street 1:1919 NE 45TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5131
Practice Address - Country:US
Practice Address - Phone:954-776-7176
Practice Address - Fax:954-776-7160
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical