Provider Demographics
NPI:1720021249
Name:KEITH, BARRY (LISW, DCSW)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:KEITH
Suffix:
Gender:M
Credentials:LISW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9248
Mailing Address - Country:US
Mailing Address - Phone:864-680-7913
Mailing Address - Fax:
Practice Address - Street 1:199 RIVER FALLS DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9248
Practice Address - Country:US
Practice Address - Phone:864-680-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW14321Medicare ID - Type Unspecified