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Individual

DR. KEITH EDWARD FENDER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D., LCSW

Contact information

Practice address
519 2ND ST, RADFORD, VA 24141-1403
(540) 639-9040
(540) 639-9040
Mailing address
519 2ND ST, RADFORD, VA 24141-1403
(540) 639-9040
(540) 639-9040

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904004405
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
337626
TRIGON/ANTHEM BLUE CROSS
VA
05
8927286
VA
Enumeration date
04/10/2006
Last updated
07/08/2007
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