MEDICARE: KEONA WRIGHT LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	37FA00032500	NJ
2	106H00000X	Marriage & Family Therapist	3060	CT
3	106H00000X	Marriage & Family Therapist	002232	NY
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	002232	NY

General Provider Information

NPI Number	:	1265117568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEONA WRIGHT LMFT

Provider Business Mailing Address
First Line	:	873 US ROUTE 1 # 1174
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3345
Country	:	US
Telephone Number	:	732-444-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 US ROUTE 1 # 1174
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-3345
Country	:	US
Telephone Number	:	732-444-7716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2023
Last Update Date	:	04/04/2024

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Directions to “ KEONA WRIGHT LMFT” Practice Location

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