MEDICARE: MR. KEITH ERWIN ANDERSON L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC997	ME

General Provider Information

NPI Number	:	1891039814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH ERWIN ANDERSON L.C.S.W.

Provider Business Mailing Address
First Line	:	3600 BROADWAY
Second Line	:	SUITE 19
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4844
Country	:	US
Telephone Number	:	561-228-8994
Fax Number	:	561-228-8689

Provider Business Practice Location Address
First Line	:	3600 BROADWAY
Second Line	:	SUITE 19
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4844
Country	:	US
Telephone Number	:	561-228-8994
Fax Number	:	561-228-8689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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