Healthcare Provider Details

I. General information

NPI: 1265514848
Provider Name (Legal Business Name): KEITH J. ALEXANDER, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 KLOCKNER RD
HAMILTON NJ
08690-3415
US

IV. Provider business mailing address

2079 KLOCKNER RD
HAMILTON NJ
08690-3415
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-0444
  • Fax: 609-586-6292
Mailing address:
  • Phone: 609-586-0444
  • Fax: 609-586-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100326600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC601700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number35SI00324900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI00157200
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2952
License Number StateNJ

VIII. Authorized Official

Name: DR. KEITH J. ALEXANDER
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 609-586-0444