Provider Demographics
NPI:1962862946
Name:KEIPERT, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KEIPERT
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:PO BOX 3016
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-1016
Mailing Address - Country:US
Mailing Address - Phone:201-488-6678
Mailing Address - Fax:201-342-4346
Practice Address - Street 1:19 SPEAR RD
Practice Address - Street 2:SUITE 301
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1235
Practice Address - Country:US
Practice Address - Phone:201-488-6678
Practice Address - Fax:201-342-4346
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00537800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional