Provider Demographics
NPI:1487703773
Name:COLETTI, KATHLEEN (DSW, LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:COLETTI
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CAPTAINS CIR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-3785
Mailing Address - Country:US
Mailing Address - Phone:302-645-1500
Mailing Address - Fax:302-258-0864
Practice Address - Street 1:16529 COASTAL HWY
Practice Address - Street 2:SUITE 121
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-3605
Practice Address - Country:US
Practice Address - Phone:302-645-1500
Practice Address - Fax:302-258-0864
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001923001041C0700X, 1041S0200X
DEQ1-00010511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool