Provider Demographics
NPI:1205391349
Name:WOODS, KEENEN
Entity type:Individual
Prefix:
First Name:KEENEN
Middle Name:
Last Name:WOODS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LAUREL RD UNIT 1711
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6760
Mailing Address - Country:US
Mailing Address - Phone:609-408-9280
Mailing Address - Fax:
Practice Address - Street 1:1801 LAUREL RD UNIT 1711
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-6760
Practice Address - Country:US
Practice Address - Phone:609-408-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health