Provider Demographics
NPI:1356215669
Name:KEYES, MICHELE MARLENE (LSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARLENE
Last Name:KEYES
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 1:70 KINGSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5034
Mailing Address - Country:US
Mailing Address - Phone:856-477-9260
Mailing Address - Fax:
Practice Address - Street 1:900 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2101
Practice Address - Country:US
Practice Address - Phone:856-477-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW142282104100000X
NJ44SL07190100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker