Provider Demographics
NPI:1235269622
Name:COLETTA, ANNETTE LISA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:LISA
Last Name:COLETTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 PINE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1619
Mailing Address - Country:US
Mailing Address - Phone:201-264-3323
Mailing Address - Fax:201-236-0228
Practice Address - Street 1:115 PINE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1619
Practice Address - Country:US
Practice Address - Phone:201-264-3323
Practice Address - Fax:201-236-0228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00324900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional