MEDICARE: KAITLYN ELIZABETH SQUITIERI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P137836	NY

General Provider Information

NPI Number	:	1588528418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ELIZABETH SQUITIERI

Provider Business Mailing Address
First Line	:	368 VETERANS MEMORIAL HWY STE 3
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-4322
Country	:	US
Telephone Number	:	631-533-0315
Fax Number	:	855-752-5170

Provider Business Practice Location Address
First Line	:	368 VETERANS MEMORIAL HWY STE 3
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-4322
Country	:	US
Telephone Number	:	631-533-0315
Fax Number	:	855-752-5170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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