Healthcare Provider Details

I. General information

NPI: 1053257907
Provider Name (Legal Business Name): KAITLIN CIPOLLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN CATTIE

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PARAGON WAY STE 800
FREEHOLD NJ
07728-9573
US

IV. Provider business mailing address

2 PARAGON WAY STE 800
FREEHOLD NJ
07728-9573
US

V. Phone/Fax

Practice location:
  • Phone: 732-393-8391
  • Fax:
Mailing address:
  • Phone: 732-393-8391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NJ15486900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: