MEDICARE: CAROLINE RACHEL KUTTLER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC013014	PA

General Provider Information

NPI Number	:	1962097766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE RACHEL KUTTLER LPC

Provider Business Mailing Address
First Line	:	710 DUDLEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2424
Country	:	US
Telephone Number	:	443-370-2246
Fax Number	:

Provider Business Practice Location Address
First Line	:	2556 FRANKFORD AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1912
Country	:	US
Telephone Number	:	443-370-2246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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