Provider Demographics
NPI:1770658916
Name:MCNUTT, KEITH BYRON (MSW, MPP, LCSW (NY))
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BYRON
Last Name:MCNUTT
Suffix:
Gender:M
Credentials:MSW, MPP, LCSW (NY)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 AFTON PL
Mailing Address - Street 2:#110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8348
Mailing Address - Country:US
Mailing Address - Phone:917-288-3067
Mailing Address - Fax:
Practice Address - Street 1:6141 AFTON PL
Practice Address - Street 2:#110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-8348
Practice Address - Country:US
Practice Address - Phone:917-288-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055068-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker