Provider Demographics
NPI:1154537686
Name:KILLEEN, PETER JAMES
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:KILLEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:JAMES
Other - Last Name:KILLEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC
Mailing Address - Street 1:9 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2929
Mailing Address - Country:US
Mailing Address - Phone:973-256-2187
Mailing Address - Fax:973-256-6016
Practice Address - Street 1:9 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2929
Practice Address - Country:US
Practice Address - Phone:973-256-2187
Practice Address - Fax:973-256-6016
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00034600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)