Provider Demographics
NPI:1679644140
Name:HERBERT, KEITH L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:L
Last Name:HERBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ALDA DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-8702
Mailing Address - Country:US
Mailing Address - Phone:845-339-1020
Mailing Address - Fax:845-339-2370
Practice Address - Street 1:49 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSENDALE
Practice Address - State:NY
Practice Address - Zip Code:12472
Practice Address - Country:US
Practice Address - Phone:845-658-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024623-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical