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General NPI Number Information
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NPI Number | 1205394087
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Entity Type | Individual
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Provider Name | HEIDI KAYE KEITH
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Gender | Female
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 100 N CALHOUN ST
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City | BALTIMORE
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State | MD
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Zip | 21223-1867
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Country | US
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Telephone | 410-525-6734
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Fax | 410-945-3031
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Provider Business Mailing Address
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Address Line | 2800 GARRETT RD
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City | WHITE HALL
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State | MD
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Zip | 21161-9738
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Country | US
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Telephone | 410-428-2421
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Fax | 410-945-3031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06275
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License Number State | MD
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