Provider Demographics
NPI:1710378047
Name:KEYES, ALLISON (LSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KEYES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112B HASTINGS WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1805
Mailing Address - Country:US
Mailing Address - Phone:908-610-9389
Mailing Address - Fax:
Practice Address - Street 1:112B HASTINGS WAY
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1805
Practice Address - Country:US
Practice Address - Phone:908-610-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05903900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker