Healthcare Provider Details

I. General information

NPI: 1912676289
Provider Name (Legal Business Name): UNITED FRONT BEHAVIORAL HEALTH LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 04/07/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ATLANTIC AVE STE G
MANASQUAN NJ
08736-1352
US

IV. Provider business mailing address

1608 SHERIDAN DR
WALL TOWNSHIP NJ
07753-7018
US

V. Phone/Fax

Practice location:
  • Phone: 732-600-4341
  • Fax:
Mailing address:
  • Phone: 732-779-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KELLI KATHERINE MARCHITELLO
Title or Position: OWNER / LPC
Credential: LPC, BCBA
Phone: 732-779-1121