Provider Demographics
NPI:1386623122
Name:KEYSER, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:KEYSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:PILGRIM GARDENS
Mailing Address - State:PA
Mailing Address - Zip Code:19026-0810
Mailing Address - Country:US
Mailing Address - Phone:610-329-1688
Mailing Address - Fax:
Practice Address - Street 1:303 W LANCASTER AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3938
Practice Address - Country:US
Practice Address - Phone:610-329-1688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S36530Medicare UPIN
753035MFPMedicare ID - Type Unspecified