Provider Demographics
NPI:1518183623
Name:KEUTMAN, LISA (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KEUTMAN
Suffix:
Gender:F
Credentials:LCSW
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 125
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:PA
Mailing Address - Zip Code:18953-0125
Mailing Address - Country:US
Mailing Address - Phone:267-218-3918
Mailing Address - Fax:
Practice Address - Street 1:233 SCHOOL DRIVE
Practice Address - Street 2:
Practice Address - City:KINTNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18930
Practice Address - Country:US
Practice Address - Phone:267-218-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148511041C0700X
NJ44SC051576001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical