| Doctor Name: | MYRON EDWARD KETTER |
| NPI Number: | 1306015656 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISW-CP, LCSW, LICSW |
| License Number: | SW 8551 |
| Business Practice Address: | 1376 Tiger Blvd Suite 210 Clemson, SC - 296312652 |
| Business Phone Number: | 8646547848 |
| Business Fax Number: | 8646545777 |
| Mailing Address: | 1376 Tiger Blvd, Suite 210 CLEMSON |
| State: | SC |
| Postal Code: | 296312652 |
| Phone Number: | 8646547848 |
| Fax Number: | 8646545777 |
| NPI Enumeration Date: | 02/20/2008 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | SW 8551 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |