Provider Demographics
NPI:1770562845
Name:KEIL, JOHN ERIC (MS,LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERIC
Last Name:KEIL
Suffix:
Gender:M
Credentials:MS,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KELLY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-9386
Mailing Address - Country:US
Mailing Address - Phone:412-795-7488
Mailing Address - Fax:412-795-7488
Practice Address - Street 1:801 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-5402
Practice Address - Country:US
Practice Address - Phone:412-417-8160
Practice Address - Fax:412-795-7488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKE813348Medicare ID - Type Unspecified