Provider Demographics
NPI:1750996229
Name:ROSS, KEITH C (BA, MS)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:ROSS
Suffix:
Gender:M
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1361
Mailing Address - Country:US
Mailing Address - Phone:732-903-8686
Mailing Address - Fax:
Practice Address - Street 1:221 LAUREL RD STE 102
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-8301
Practice Address - Country:US
Practice Address - Phone:732-903-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor