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General NPI Number Information
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NPI Number | 1477239655
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Entity Type | Individual
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Provider Name | LISSET D COLETTI ORREGO
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Gender | Female
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 100 ENTERPRISE DR STE 301
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City | ROCKAWAY
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State | NJ
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Zip | 07866-2129
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 263 BLOOMFIELD AVE APT 11
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-4867
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Country | US
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Telephone | 862-282-6264
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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 | CERT1-23-68649
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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