Healthcare Provider Details

I. General information

NPI: 1427296474
Provider Name (Legal Business Name): MARIA KECHAIDIS ED.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W MAIN ST
FREEHOLD NJ
07728-2144
US

IV. Provider business mailing address

PO BOX 6902
FREEHOLD NJ
07728-6902
US

V. Phone/Fax

Practice location:
  • Phone: 732-766-6067
  • Fax: 732-791-1408
Mailing address:
  • Phone: 732-766-6067
  • Fax: 732-791-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00382200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005989L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: