1912519992 NPI number — KAITLYN MARY KUDRAVITSKY M.A., LPC, NCC

NPI Number: 1912519992
Health Care Provider/Practitioner: KAITLYN MARY KUDRAVITSKY M.A., LPC, NCC

NPI Number : 1912519992 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912519992",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KUDRAVITSKY",
    "FirstName": "KAITLYN",
    "MiddleName": "MARY",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A., LPC, NCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GILMARTIN",
    "OtherFirstName": "KAITLYN",
    "OtherMiddleName": "MARY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "M.A., LAC, NCC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4345 U.S. HIGHWAY 9 STE 7",
    "SecondLineMailingAddress": "#1014",
    "MailingAddressCityName": "FREEHOLD",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07728",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "36 KRESSON RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHERRY HILL",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08034-3227",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "888-687-9516",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/20/2020",
    "LastUpdateDate": "08/16/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "37PC00975700",
        "LicenseNumberStateCode": "NJ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}