Provider Demographics
NPI:1477080448
Name:KEIDEL, EMMA (LICSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KEIDEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1718 EVELYN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4127
Mailing Address - Country:US
Mailing Address - Phone:301-785-8309
Mailing Address - Fax:
Practice Address - Street 1:89 ACCESS RD STE 24
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5233
Practice Address - Country:US
Practice Address - Phone:301-785-8309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223152104100000X
MA1225761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker