Healthcare Provider Details

I. General information

NPI: 1508268038
Provider Name (Legal Business Name): KELLY COLLIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SCHOOL HOUSE RD
OAK RIDGE NJ
07438-9825
US

IV. Provider business mailing address

97 SCHOOL HOUSE RD
OAK RIDGE NJ
07438-9825
US

V. Phone/Fax

Practice location:
  • Phone: 973-650-7605
  • Fax:
Mailing address:
  • Phone: 973-650-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number15BC00140500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: