Provider Demographics
NPI:1558883959
Name:KEATLEY, JUDITH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:KEATLEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-0071
Mailing Address - Country:US
Mailing Address - Phone:304-620-5512
Mailing Address - Fax:
Practice Address - Street 1:239 CHIMNEY DR
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-3171
Practice Address - Country:US
Practice Address - Phone:304-620-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009445121041C0700X
WVBP009445121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty