Healthcare Provider Details

I. General information

NPI: 1275677866
Provider Name (Legal Business Name): KATHLEEN M. CARLETTA A.P.R.N., B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EVERGREEN PL YCS NINTH FLOOR HEALTH SERVICES
EAST ORANGE NJ
07018-2106
US

IV. Provider business mailing address

446 THE FENWAY
RIVER EDGE NJ
07661-1838
US

V. Phone/Fax

Practice location:
  • Phone: 973-854-3630
  • Fax: 973-854-3631
Mailing address:
  • Phone: 201-261-6862
  • Fax: 973-854-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00081900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: