Individual
TARA COLLETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSSPED
Contact information
Practice address
252 ISLIP AVE, ISLIP, NY 11751-3029
(631) 581-6800
Mailing address
66 JUNIPER ST, ISLIP, NY 11751-1213
(631) 581-1007
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1838938
NY
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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