Individual
MR. KEITH JOHN TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
88-02 ROCKAWAY BEACH BLVD, ROCKAWAY BEACH, NY 11691
(718) 327-7002
Mailing address
88-02 ROCKAWAY BEACH BLVD, ROCKAWAY BEACH, NY 11691
(718) 327-7002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
38720
NY
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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