Healthcare Provider Details

I. General information

NPI: 1194395004
Provider Name (Legal Business Name): KAITLYN ZUPKA LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S WILLOW ST UNIT 17
MANCHESTER NH
03103-3209
US

IV. Provider business mailing address

467 WAUKEWAN RD
CENTER HARBOR NH
03226-3243
US

V. Phone/Fax

Practice location:
  • Phone: 631-875-3226
  • Fax:
Mailing address:
  • Phone: 631-875-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2699
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007682
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: