Provider Demographics
NPI:1093781528
Name:KEISER, GLORIA S (MSW)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:S
Last Name:KEISER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2977
Mailing Address - Country:US
Mailing Address - Phone:954-803-3238
Mailing Address - Fax:954-722-0055
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:SUITE 207
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2977
Practice Address - Country:US
Practice Address - Phone:954-803-3238
Practice Address - Fax:954-722-0055
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00002951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6705OtherBLUE CROSS
FL1012614OtherCIGNA
FL1012614OtherCIGNA