Provider Demographics
NPI:1265117568
Name:WRIGHT, KEONA (LMFT)
Entity type:Individual
Prefix:
First Name:KEONA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 US ROUTE 1 # 1174
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-3345
Mailing Address - Country:US
Mailing Address - Phone:732-444-7716
Mailing Address - Fax:
Practice Address - Street 1:873 US ROUTE 1 # 1174
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-3345
Practice Address - Country:US
Practice Address - Phone:732-444-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00032500106H00000X
CT3060106H00000X
NY002232106H00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist