Provider Demographics
NPI:1427675305
Name:KEITH, SONYA LORRAINE
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:LORRAINE
Last Name:KEITH
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 1:11419 DRONFIELD TER
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-1449
Mailing Address - Country:US
Mailing Address - Phone:626-755-8015
Mailing Address - Fax:
Practice Address - Street 1:11419 DRONFIELD TER
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1449
Practice Address - Country:US
Practice Address - Phone:626-755-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 172V00000X, 376J00000X, 104100000X
CA84457101YM0800X
CA115415104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No172V00000XOther Service ProvidersCommunity Health Worker
No376J00000XNursing Service Related ProvidersHomemaker