Fender, Keith Edward
Fender, Keith Edward is an sole proprietor health care provider with primary practice located at 519 2Nd St , Radford VA 24141-1403. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Fender, Keith Edward can be contacted via phone (540) 639-9040.Contact Information
Primary practice address
519 2Nd St
Radford VA 24141-1403
Phone: (540) 639-9040
Fax: (540) 639-9040
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 0904004405 | Virginia |
Profile Details
| NPI number | 1568425635 |
|---|---|
| LBN Legal business name | Fender, Keith Edward |
| Credentials | PH.D., LCSW |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 10th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568425635 | NPPES |
| Virginia | MEDICAID | 8927286 | |
| Virginia | Other | 337626 |
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