Provider Demographics
NPI:1962823765
Name:CUCURULLO, KAITLYN (LMHC, MS)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CUCURULLO
Suffix:
Gender:F
Credentials:LMHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 TARKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8770
Mailing Address - Country:US
Mailing Address - Phone:203-914-2476
Mailing Address - Fax:
Practice Address - Street 1:89 TARKLIN RD
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8770
Practice Address - Country:US
Practice Address - Phone:203-914-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health