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General NPI Number Information
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NPI Number | 1194932384
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Entity Type | Individual
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Provider Name | MICHAEL K KEENE SR. D.MIN
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 102 HERTIAGE VALLEY ROAD SUITE C
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City | SEWELL
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State | NJ
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Zip | 08080
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Country | US
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Telephone | 856-812-2924
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Fax |
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Provider Business Mailing Address
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Address Line | 133 KING AVE
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City | WOODBURY HEIGHTS
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State | NJ
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Zip | 08097-1622
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Country | US
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Telephone | 856-468-2315
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Fax | 856-468-0816
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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