Provider Demographics
NPI:1487893764
Name:MASKREY, KEVIN D (LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:MASKREY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 REDGATE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1518
Mailing Address - Country:US
Mailing Address - Phone:757-626-3733
Mailing Address - Fax:757-626-3331
Practice Address - Street 1:930 REDGATE AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1518
Practice Address - Country:US
Practice Address - Phone:757-626-3733
Practice Address - Fax:757-626-3331
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical