Healthcare Provider Details

I. General information

NPI: 1720021249
Provider Name (Legal Business Name): BARRY KEITH LISW, DCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 RIVER FALLS DR
DUNCAN SC
29334-9248
US

IV. Provider business mailing address

199 RIVER FALLS DR
DUNCAN SC
29334-9248
US

V. Phone/Fax

Practice location:
  • Phone: 864-680-7913
  • Fax:
Mailing address:
  • Phone: 864-680-7913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9318
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: