Provider Demographics
NPI:1457110397
Name:KEYES, SAMANTHA MARIE (MA, LAC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:KEYES
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 NJ-31 S
Mailing Address - Street 2:BEAVER BROOK CONCOURSE, SUITE 7
Mailing Address - City:ANNANDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08801
Mailing Address - Country:US
Mailing Address - Phone:908-237-2577
Mailing Address - Fax:908-894-5309
Practice Address - Street 1:1465 NJ-31 S
Practice Address - Street 2:BEAVER BROOK CONCOURSE, SUITE 7
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801
Practice Address - Country:US
Practice Address - Phone:908-237-2577
Practice Address - Fax:908-894-5309
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00401600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health