Provider Demographics
NPI:1902629645
Name:BROOKER, KEYSHA DENNE (LSW)
Entity type:Individual
Prefix:
First Name:KEYSHA
Middle Name:DENNE
Last Name:BROOKER
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 1:2101 S COLLEGE AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4858
Mailing Address - Country:US
Mailing Address - Phone:267-688-6073
Mailing Address - Fax:
Practice Address - Street 1:2101 S COLLEGE AVE APT 208
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4858
Practice Address - Country:US
Practice Address - Phone:267-688-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker