Provider Demographics
NPI:1225872062
Name:LOTITO, KELSIE ALEXA (PMHNP)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:ALEXA
Last Name:LOTITO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CHERRY TREE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1740
Mailing Address - Country:US
Mailing Address - Phone:646-707-7515
Mailing Address - Fax:
Practice Address - Street 1:470 PROSPECT AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4106
Practice Address - Country:US
Practice Address - Phone:973-325-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15159400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health