Tabetha Tapiwa-Rose Keita

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Practice address

414 Marc Dr
Toms River, NJ 08753-4228

Phone

(732) 270-4823

Fax

(732) 270-4951

NPI assigned

Sep 29, 2022

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 29, 2022.

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1508580945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2036",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087018036",
            "telephone_number": "732-270-4823",
            "fax_number": "732-270-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 MARC DR",
            "city": "TOMS RIVER",
            "state": "NJ",
            "postal_code": "087534228",
            "telephone_number": "732-270-4823",
            "fax_number": "732-270-4951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1081 Lakewood Rd",
            "address_purpose": "LOCATION",
            "city": "Toms River",
            "state": "NJ",
            "postal_code": "087534168",
            "country_code": "US",
            "telephone_number": "732-286-7962",
            "fax_number": "732-286-7963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1081 Rt 539",
            "address_purpose": "LOCATION",
            "city": "Whiting",
            "state": "NJ",
            "postal_code": "08759",
            "country_code": "US",
            "telephone_number": "732-716-0700",
            "fax_number": "732-716-0934",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Hamlet Ct",
            "address_purpose": "LOCATION",
            "city": "Toms River",
            "state": "NJ",
            "postal_code": "087536405",
            "country_code": "US",
            "telephone_number": "732-349-2335",
            "fax_number": "732-349-2208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEITA",
        "first_name": "TABETHA",
        "middle_name": "TAPIWA-ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029807",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiraphorn Keaveny
• Thomas Andrew Kedersha, M.D.
• Eileen M. Keegan, MSW LCSW
• Taylor Mackenzie Keehn, LAC,NCC
• Emily Keenan, LCSW
• Tyler E Keller
• Melanie Rose Kellner, LCSW, LCADC
• Audrey Leah Kelly, EDD, APNC
• Riva Kelly, DO
• Shannon Cathleen Kelly, APN

• All providers in Toms River, NJ
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.