Provider Demographics
NPI:1336982073
Name:KEATING, TIMOTHY JR (LSW, LCADC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:KEATING
Suffix:JR
Gender:M
Credentials:LSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2213
Mailing Address - Country:US
Mailing Address - Phone:856-477-1218
Mailing Address - Fax:
Practice Address - Street 1:1 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2213
Practice Address - Country:US
Practice Address - Phone:856-477-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06709200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)