Healthcare Provider Details

I. General information

NPI: 1942974456
Provider Name (Legal Business Name): TAYLOR KEEFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

IV. Provider business mailing address

313 MACK PL
NEW MILFORD NJ
07646-1234
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00591600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: