Provider Demographics
NPI:1114280864
Name:KESERU, BEATRICE RENATA (LAC)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:RENATA
Last Name:KESERU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 RAVENS CREST DR E
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2470
Mailing Address - Country:US
Mailing Address - Phone:862-220-2644
Mailing Address - Fax:
Practice Address - Street 1:543 VALLEY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1881
Practice Address - Country:US
Practice Address - Phone:908-616-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00103600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor