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General NPI Number Information
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NPI Number | 1912519992
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Entity Type | Individual
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Provider Name | KAITLYN MARY KUDRAVITSKY M.A., LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 36 KRESSON RD
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3227
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Country | US
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Telephone | 888-687-9516
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Fax |
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Provider Business Mailing Address
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Address Line | 4345 U.S. HIGHWAY 9 STE 7 #1014
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00975700
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License Number State | NJ
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