Provider Demographics
NPI:1013698638
Name:MURRAY, KEYAUNTA VANESSA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KEYAUNTA
Middle Name:VANESSA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2812
Mailing Address - Country:US
Mailing Address - Phone:443-824-6172
Mailing Address - Fax:
Practice Address - Street 1:107 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5213
Practice Address - Country:US
Practice Address - Phone:410-558-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30395104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker