Healthcare Provider Details

I. General information

NPI: 1083540355
Provider Name (Legal Business Name): STACEY KEILMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 OLD SCALP AVE STE 276
JOHNSTOWN PA
15904-1763
US

IV. Provider business mailing address

525 BEDFORD ST
WINDBER PA
15963-1230
US

V. Phone/Fax

Practice location:
  • Phone: 814-713-1840
  • Fax: 814-420-4470
Mailing address:
  • Phone: 814-521-0520
  • Fax: 814-420-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020042
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: