Provider Demographics
NPI:1114254737
Name:GULOTTA, JACLYN LEE (LMHC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:LEE
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:LMHC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WHEELHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-0016
Mailing Address - Country:US
Mailing Address - Phone:407-257-1066
Mailing Address - Fax:
Practice Address - Street 1:220 LOOKOUT PL STE 200
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8408
Practice Address - Country:US
Practice Address - Phone:407-257-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health