Individual
TABETHA TAPIWA-ROSE KEITA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
414 MARC DR, TOMS RIVER, NJ 08753-4228
(732) 270-4823
(732) 270-4951
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
(732) 270-4823
(732) 270-4951
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
09/29/2022
Last updated
09/29/2022
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