Provider Demographics
NPI:1164590329
Name:FITZGERALD KEYSER, KELLEY ANNETTE (ASW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ANNETTE
Last Name:FITZGERALD KEYSER
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:ANNETTE
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:1625 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5211
Mailing Address - Country:US
Mailing Address - Phone:619-441-1907
Mailing Address - Fax:619-441-1908
Practice Address - Street 1:200 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4888
Practice Address - Country:US
Practice Address - Phone:443-984-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health