Healthcare Provider Details

I. General information

NPI: 1174230684
Provider Name (Legal Business Name): KAITLYN SANTUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 STIRLING RD
WATCHUNG NJ
07069-5900
US

IV. Provider business mailing address

40 STIRLING RD
WATCHUNG NJ
07069-5900
US

V. Phone/Fax

Practice location:
  • Phone: 908-251-9994
  • Fax:
Mailing address:
  • Phone: 908-251-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00927000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: