Provider Demographics
NPI:1134890106
Name:MARCHITELLO, KELLI KATHERINE (LPC, BCBA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:KATHERINE
Last Name:MARCHITELLO
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7018
Mailing Address - Country:US
Mailing Address - Phone:732-779-1121
Mailing Address - Fax:
Practice Address - Street 1:200 ATLANTIC AVE STE G
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1352
Practice Address - Country:US
Practice Address - Phone:732-600-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-14-17885103K00000X
NJ37PC00470500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional