Provider Demographics
NPI:1487217493
Name:OKEEFE, HOLLIE SUE
Entity Type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:SUE
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GRASSY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHAMONG
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-8917
Mailing Address - Country:US
Mailing Address - Phone:609-801-2939
Mailing Address - Fax:
Practice Address - Street 1:115 GRASSY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-8917
Practice Address - Country:US
Practice Address - Phone:609-801-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00561600101YM0800X
PAPC006921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty