Provider Demographics
NPI:1295859767
Name:KEATING, NANCY R (LCSW-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:KEATING
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-0735
Mailing Address - Country:US
Mailing Address - Phone:410-666-1105
Mailing Address - Fax:
Practice Address - Street 1:2360 JOPPA ROAD
Practice Address - Street 2:GREENSPRING STATION, SUITE 316
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-666-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08436 LCSWC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11248902OtherCAQH PROV #