Provider Demographics
NPI:1275372708
Name:GOFF, KAITLYN MARIE (LAC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:GOFF
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2488
Mailing Address - Country:US
Mailing Address - Phone:908-202-0678
Mailing Address - Fax:
Practice Address - Street 1:100 CRAIG RD STE 220
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8731
Practice Address - Country:US
Practice Address - Phone:732-913-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00787400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health