Provider Demographics
NPI:1518723907
Name:KEITH, JAMES EDWARD (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:KEITH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 GRAVIER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2104
Mailing Address - Country:US
Mailing Address - Phone:504-343-7675
Mailing Address - Fax:
Practice Address - Street 1:1530 GRAVIER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2104
Practice Address - Country:US
Practice Address - Phone:504-452-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16768104100000X
AL5946G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker