Provider Demographics
NPI:1225374812
Name:ULITSKY, CAROLYN (CA-CMT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ULITSKY
Suffix:
Gender:F
Credentials:CA-CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 AL COSTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-719-3228
Mailing Address - Fax:925-425-0662
Practice Address - Street 1:12811 AL COSTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-719-3228
Practice Address - Fax:925-425-0662
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist