Provider Demographics
NPI:1457930869
Name:DERIGGI, KELLY ELIZABETH
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:DERIGGI
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 1:2467 ROUTE 10 BLDG 36-7B
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1355
Mailing Address - Country:US
Mailing Address - Phone:862-209-0167
Mailing Address - Fax:
Practice Address - Street 1:2467 ROUTE 10 BLDG 36-7B
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1355
Practice Address - Country:US
Practice Address - Phone:862-209-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-04
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
799046720OtherOSCAR