=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356215669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE MARLENE KEYES LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2025
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 HADDON AVE
-----------------------------------------------------
City | COLLINGSWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08108-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-477-9260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 KINGSBRIDGE DR
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-5034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-477-9260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW142282
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 44SL07190100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------