Provider Demographics
NPI:1164933081
Name:O'KEEFE, ALYSSA (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:O'KEEFE
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1420
Mailing Address - Country:US
Mailing Address - Phone:551-221-1759
Mailing Address - Fax:
Practice Address - Street 1:175 WILSON AVE
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758-1420
Practice Address - Country:US
Practice Address - Phone:551-221-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00288300101YM0800X
NJ37PC00655500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid