Provider Demographics
NPI:1952057598
Name:KEYSTONE THERAPY AND TRAINING SERVICES INC
Entity Type:Organization
Organization Name:KEYSTONE THERAPY AND TRAINING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-327-0909
Mailing Address - Street 1:4415 SONOMA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4165
Mailing Address - Country:US
Mailing Address - Phone:707-327-0909
Mailing Address - Fax:
Practice Address - Street 1:4415 SONOMA HWY STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4165
Practice Address - Country:US
Practice Address - Phone:707-327-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty