Basic Information
| Provider Information | |||||||||
| NPI: | 1659678407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEEFER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ABBOTT | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ABBOTT | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 126 W 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502862090 | ||||||||
| FaxNumber: | 6502862092 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 W 25TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502862090 | ||||||||
| FaxNumber: | 6502862092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2011 | ||||||||
| LastUpdateDate: | 02/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 28351 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.