Provider Demographics
NPI:1841540507
Name:WINT, KEISHA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:M
Last Name:WINT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 MILLBURN AVE
Mailing Address - Street 2:SECOND FLOOR, SUITE 6
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1849
Mailing Address - Country:US
Mailing Address - Phone:973-467-6777
Mailing Address - Fax:888-975-7511
Practice Address - Street 1:159 MILLBURN AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1849
Practice Address - Country:US
Practice Address - Phone:973-467-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
NJ44SC052132001041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool