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General NPI Number Information
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NPI Number | 1134890106
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Entity Type | Individual
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Provider Name | KELLI KATHERINE MARCHITELLO LPC, BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 200 ATLANTIC AVE STE G
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City | MANASQUAN
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State | NJ
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Zip | 08736-1352
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Country | US
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Telephone | 732-600-4341
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 SHERIDAN DR
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07753-7018
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Country | US
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Telephone | 732-779-1121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17885
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00470500
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License Number State | NJ
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