Healthcare Provider Details

I. General information

NPI: 1962097766
Provider Name (Legal Business Name): CAROLINE RACHEL KUTTLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2556 FRANKFORD AVENUE
PHILADELPHIA PA
19125-1912
US

IV. Provider business mailing address

710 DUDLEY ST
PHILADELPHIA PA
19148-2424
US

V. Phone/Fax

Practice location:
  • Phone: 443-370-2246
  • Fax:
Mailing address:
  • Phone: 443-370-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013014
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: