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General NPI Number Information
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NPI Number | 1356932941
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Entity Type | Individual
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Provider Name | JUDITH C KULAKOFSKY LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 304 W MAIN ST STE 2
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City | AVON
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State | CT
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Zip | 06001-4355
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Country | US
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Telephone | 860-874-8561
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HIGH MEADOW RD
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City | BLOOMFIELD
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State | CT
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Zip | 06002-2133
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Country | US
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Telephone | 860-874-8561
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2532
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License Number State | CT
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