Healthcare Provider Details

I. General information

NPI: 1558883959
Provider Name (Legal Business Name): JUDITH KEATLEY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH GRIFFITH

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 06/18/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 CHIMNEY DR
BUNKER HILL WV
25413-3171
US

IV. Provider business mailing address

PO BOX 71
BUNKER HILL WV
25413-0071
US

V. Phone/Fax

Practice location:
  • Phone: 304-620-5512
  • Fax:
Mailing address:
  • Phone: 304-620-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00944512
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: