Provider Demographics
NPI:1669066619
Name:KEYSTONE THERAPY AND TRAUMA SERVICES
Entity type:Organization
Organization Name:KEYSTONE THERAPY AND TRAUMA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:410-440-9953
Mailing Address - Street 1:3428 SONOMA LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-8619
Mailing Address - Country:US
Mailing Address - Phone:410-440-9953
Mailing Address - Fax:
Practice Address - Street 1:1224 S QUEEN ST STE 206
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3961
Practice Address - Country:US
Practice Address - Phone:410-440-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty