Provider Demographics
NPI:1932277142
Name:KEIM, MARY JANE (MSW)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:KEIM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 W GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5624
Mailing Address - Country:US
Mailing Address - Phone:865-522-6060
Mailing Address - Fax:865-522-9218
Practice Address - Street 1:518 W GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5624
Practice Address - Country:US
Practice Address - Phone:865-522-6060
Practice Address - Fax:865-522-9218
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical