Keith Edward Fender, PH.D., LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904004405 Issued in VA

Practice address

519 2ND St
Radford, VA 24141-1403

Phone

(540) 639-9040

Fax

(540) 639-9040

NPI assigned

Apr 10, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blueridge Counseling Services

  • Clinical Social Worker
  • Radford, VA
  • NPI 1053448878
  NPD (past) Authorized official
• Radford Counseling Group LLC

  • Clinical Social Worker
  • Radford, VA
  • NPI 1669527958
  NPD (past) Authorized official
• T Med Behavioral Inc

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1497719272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568425635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "519 2ND ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411403",
            "telephone_number": "540-639-9040",
            "fax_number": "540-639-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 2ND ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411403",
            "telephone_number": "540-639-9040",
            "fax_number": "540-639-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDER",
        "first_name": "KEITH",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PH.D., LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904004405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIGON/ANTHEM BLUE CROSS",
            "identifier": "337626",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8927286",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family Health Clinic, Inc.
• Family Preservation Services, Inc
• FC of Virginia Inc (Intrepid USA Healthcare Services)
• Abby Elizabeth Federici
• Jerry Lynn Felger, D.C.
• Ashley Fertall
• Susan Ranee' Fisher, FNP-BC
• Miranda Flatz
• Erin Fluri
• Anastasia Formica, MA, BCBA, LBA

• Clinical Social Worker in Radford, VA
• Providers in Radford, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.