Healthcare Provider Details

I. General information

NPI: 1356228563
Provider Name (Legal Business Name): MY POTENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E 2ND ST
SCOTCH PLAINS NJ
07076-1749
US

IV. Provider business mailing address

1801 E 2ND ST
SCOTCH PLAINS NJ
07076-1749
US

V. Phone/Fax

Practice location:
  • Phone: 908-956-1301
  • Fax:
Mailing address:
  • Phone: 908-956-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARISSA COSSOLINI
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: OTR/L
Phone: 551-697-0030