Healthcare Provider Details

I. General information

NPI: 1972748416
Provider Name (Legal Business Name): STEPHANIE L KEFFER M.S.NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SOUTH QUEEN STREET BERKELEY COUNTY BOARD OF EDUCATION
MARTINSBURG WV
25401
US

IV. Provider business mailing address

110 SYCAMORE PLACE
CROSS JUNCTION VA
22625
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3500
  • Fax:
Mailing address:
  • Phone: 304-267-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4285
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: