Provider Demographics
NPI:1821448523
Name:KEY, MICHAEL (LICSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5568
Mailing Address - Country:US
Mailing Address - Phone:774-826-1466
Mailing Address - Fax:774-826-1008
Practice Address - Street 1:940 BELMONT STREET
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-1466
Practice Address - Fax:774-826-1008
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW007066101YM0800X
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health