Provider Demographics
NPI:1861524985
Name:OLIVER, KEITH BERNARD
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BERNARD
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 DAVIDSON AVE
Mailing Address - Street 2:APARTMENT 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7861
Mailing Address - Country:US
Mailing Address - Phone:719-960-0408
Mailing Address - Fax:
Practice Address - Street 1:1702 DAVIDSON AVE
Practice Address - Street 2:APARTMENT 3A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7861
Practice Address - Country:US
Practice Address - Phone:719-960-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health