Provider Demographics
NPI:1821110149
Name:KEITH, BRENDA SUE (CMSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:KEITH
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 BRET RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4314
Mailing Address - Country:US
Mailing Address - Phone:615-305-9754
Mailing Address - Fax:
Practice Address - Street 1:633 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3616
Practice Address - Country:US
Practice Address - Phone:615-460-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker