Provider Demographics
NPI:1679689178
Name:BARONSKY, KEITH SCHADE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KEITH
Middle Name:SCHADE
Last Name:BARONSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:60 MDG/SGOW
Mailing Address - Street 2:101 BODIN CIR
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1800
Mailing Address - Country:US
Mailing Address - Phone:707-423-5168
Mailing Address - Fax:
Practice Address - Street 1:60 MDG/SGOW
Practice Address - Street 2:101 BODIN CIR
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-5168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0006731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13261OtherBCBS
NC6002060Medicaid
13261OtherBCBS