=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588072813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEISHA N QUEEN-MCKAY LSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2014
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2489 SCHULTZ WAY
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-900-5002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 DODWORTH CT APT 104
-----------------------------------------------------
City | TIMONIUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-900-5002
-----------------------------------------------------
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 | 32811
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------