Healthcare Provider Details

I. General information

NPI: 1770562845
Provider Name (Legal Business Name): JOHN ERIC KEIL MS,LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 FREEPORT RD
NEW KENSINGTON PA
15068-5402
US

IV. Provider business mailing address

100 KELLY RIDGE RD
NEW KENSINGTON PA
15068-9386
US

V. Phone/Fax

Practice location:
  • Phone: 412-417-8160
  • Fax: 412-795-7488
Mailing address:
  • Phone: 412-795-7488
  • Fax: 412-795-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014078
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: