Provider Demographics
NPI:1710469309
Name:KEITH-PODBELSKI, CHERYL (LICSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KEITH-PODBELSKI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1343
Mailing Address - Country:US
Mailing Address - Phone:508-243-3145
Mailing Address - Fax:
Practice Address - Street 1:4 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1343
Practice Address - Country:US
Practice Address - Phone:508-243-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019769104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
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