Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 44SC04855300 | NJ |
NPI | 1982722591 |
---|---|
Provider Name | Ms. Mary Beth Kneis |
First Address | Sparta, NJ 07871-1933 |
Second Address | Sparta, NJ 07871-1933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P263017 | OXFORD (01) | NJ |