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General NPI Number Information
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NPI Number | 1285217547
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Entity Type | Individual
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Provider Name | KAITLYNN B. CORNELL-MULLANE LCAT, RDT, MA
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Gender | Female
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 802 SENECA AVE APT 3L
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4810
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Country | US
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Telephone | 845-901-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 802 SENECA AVE APT 3L
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4810
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Country | US
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Telephone | 845-901-2799
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002579
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 002579
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number | 002579
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License Number State | NY
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