1891039814 NPI number — MR. KEITH ERWIN ANDERSON L.C.S.W.

Table of content: MR. KEITH ERWIN ANDERSON L.C.S.W. (NPI 1891039814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891039814 NPI number — MR. KEITH ERWIN ANDERSON L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
KEITH
Provider Middle Name:
ERWIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891039814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 19
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-4844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-228-8994
Provider Business Mailing Address Fax Number:
561-228-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 19
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-228-8994
Provider Business Practice Location Address Fax Number:
561-228-8689
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC997 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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