Provider Demographics
NPI:1932646197
Name:COLETTI, DANA MARIE
Entity Type:Individual
Prefix:
First Name:DANA MARIE
Middle Name:
Last Name:COLETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6612
Mailing Address - Country:US
Mailing Address - Phone:917-709-0653
Mailing Address - Fax:
Practice Address - Street 1:2304 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6612
Practice Address - Country:US
Practice Address - Phone:917-709-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency