Provider Demographics
NPI:1427296474
Name:KECHAIDIS, MARIA (EDM)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:KECHAIDIS
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6902
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-6902
Mailing Address - Country:US
Mailing Address - Phone:732-766-6067
Mailing Address - Fax:732-791-1408
Practice Address - Street 1:90 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2144
Practice Address - Country:US
Practice Address - Phone:732-766-6067
Practice Address - Fax:732-791-1408
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00382200101YP2500X
PAPS005989L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist