Provider Demographics
NPI:1851837157
Name:ENGEL, KEITH OSO (LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:OSO
Last Name:ENGEL
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 N COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-3408
Mailing Address - Country:US
Mailing Address - Phone:804-409-7525
Mailing Address - Fax:804-315-9380
Practice Address - Street 1:3530 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140-3408
Practice Address - Country:US
Practice Address - Phone:804-409-7525
Practice Address - Fax:805-315-9380
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089301248301041C0700X
390200000X
VA09040122191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA85-3101757OtherMIND MELD PSYCHOTHERAPY