Provider Demographics
NPI:1366731416
Name:HERSH, KEITH A (MS BCBA)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:A
Last Name:HERSH
Suffix:
Gender:M
Credentials:MS BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2472
Mailing Address - Country:US
Mailing Address - Phone:502-409-7181
Mailing Address - Fax:866-859-3937
Practice Address - Street 1:811 NORTHGATE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6419
Practice Address - Country:US
Practice Address - Phone:502-417-9830
Practice Address - Fax:866-859-3937
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-04-2095103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst