Provider Demographics
NPI:1740443720
Name:OTUNUYA, KEVA RENEE
Entity type:Individual
Prefix:MS
First Name:KEVA
Middle Name:RENEE
Last Name:OTUNUYA
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 1:2375 MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2161
Mailing Address - Country:US
Mailing Address - Phone:908-232-7680
Mailing Address - Fax:
Practice Address - Street 1:80 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945
Practice Address - Country:US
Practice Address - Phone:973-543-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor