Provider Demographics
NPI:1194932384
Name:KEENE, MICHAEL K SR (DMIN)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:KEENE
Suffix:SR
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 KING AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1622
Mailing Address - Country:US
Mailing Address - Phone:856-468-2315
Mailing Address - Fax:856-468-0816
Practice Address - Street 1:102 HERTIAGE VALLEY ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-812-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist