Healthcare Provider Details

I. General information

NPI: 1487703773
Provider Name (Legal Business Name): KATHLEEN COLETTI DSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16529 COASTAL HWY SUITE 121
LEWES DE
19958-3605
US

IV. Provider business mailing address

324 CAPTAINS CIR
LEWES DE
19958-3785
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-1500
  • Fax: 302-258-0864
Mailing address:
  • Phone: 302-645-1500
  • Fax: 302-258-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00192300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number44SC00192300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001051
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: