Healthcare Provider Details

I. General information

NPI: 1104283639
Provider Name (Legal Business Name): MICHELLE K KEATING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 RT 47 SOUTH
RIO GRANDE NJ
08242
US

IV. Provider business mailing address

1076 RT. 47 SOUTH
RIO GRANDE NJ
08242
US

V. Phone/Fax

Practice location:
  • Phone: 609-741-6363
  • Fax: 609-939-4450
Mailing address:
  • Phone: 609-741-6363
  • Fax: 609-939-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05648500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: