Provider Demographics
NPI:1932351855
Name:KETRON, MAISIE LASHER (MSW)
Entity Type:Individual
Prefix:
First Name:MAISIE
Middle Name:LASHER
Last Name:KETRON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KETRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:620 GUERRERO ST
Mailing Address - Street 2:APT 7
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1591
Mailing Address - Country:US
Mailing Address - Phone:415-412-2121
Mailing Address - Fax:
Practice Address - Street 1:15200 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1013
Practice Address - Country:US
Practice Address - Phone:510-352-9690
Practice Address - Fax:510-352-9008
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical