Basic Information
| Provider Information | |||||||||
| NPI: | 1619964285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIEFFER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 337 KILGARVAN CT | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956889203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074469039 | ||||||||
| FaxNumber: | 7074233501 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 BODIN CIR | ||||||||
| Address2: | |||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233701 | ||||||||
| FaxNumber: | 7074233501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 174 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.