Provider Demographics
NPI:1326337957
Name:DE ROSA, KELLI ANNE (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ANNE
Last Name:DE ROSA
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POTASH RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1612
Mailing Address - Country:US
Mailing Address - Phone:201-644-0760
Mailing Address - Fax:
Practice Address - Street 1:25 POTASH RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1612
Practice Address - Country:US
Practice Address - Phone:201-644-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-10-7597103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst