Provider Demographics
NPI:1225875818
Name:PEARSON, KEISHA (LSW)
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5918
Mailing Address - Country:US
Mailing Address - Phone:862-378-0780
Mailing Address - Fax:
Practice Address - Street 1:69 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5918
Practice Address - Country:US
Practice Address - Phone:201-488-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12102001041S0200X
NJ44SL07043600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool