Provider Demographics
NPI:1639317407
Name:KEYWORTH, MICHELLE ELLEN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELLEN
Last Name:KEYWORTH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-889-6147
Mailing Address - Fax:603-594-9649
Practice Address - Street 1:15 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-889-6147
Practice Address - Fax:603-594-9649
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical