Provider Demographics
NPI:1518271261
Name:DEAN, KEITH SCOTT (LCSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:SCOTT
Last Name:DEAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:BARUCH
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1506 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4543
Mailing Address - Country:US
Mailing Address - Phone:917-582-8112
Mailing Address - Fax:
Practice Address - Street 1:1506 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4543
Practice Address - Country:US
Practice Address - Phone:917-582-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0505811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical