Individual
KEYYANNA MOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
62 WARNER AVE, JERSEY CITY, NJ 07305-2931
(201) 877-6354
Mailing address
409 OCEAN AVE, JERSEY CITY, NJ 07305-3033
(201) 978-2805
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/12/2019
Last updated
08/18/2020
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