Provider Demographics
NPI:1629120084
Name:SUMMERS-KEATING, AIMEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:
Last Name:SUMMERS-KEATING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON ST # 348
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4883
Mailing Address - Country:US
Mailing Address - Phone:973-363-9711
Mailing Address - Fax:
Practice Address - Street 1:401 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-7929
Practice Address - Country:US
Practice Address - Phone:312-622-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0217061041C0700X
PACW0244591041C0700X
NJ44SC061389001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080AMedicaid
KS100098080COtherSED WAIVER
KS1629120084Medicaid