Provider Demographics
NPI:1114083821
Name:MULCAHY, KAITLIN (LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NORMAL AVE.
Mailing Address - Street 2:CENTER FOR AUTISM AND EARLY CHILDHOOD MENTAL HEALTH
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:973-655-6692
Mailing Address - Fax:973-655-5376
Practice Address - Street 1:14 NORMAL AVE.
Practice Address - Street 2:CENTER FOR AUTISM AND EARLY CHILDHOOD MENTAL HEALTH
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:973-655-6692
Practice Address - Fax:973-655-5376
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199306101YM0800X
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health