Provider Demographics
NPI:1407366800
Name:KUTSUKOS, JOANN (LMHC, CAP)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:KUTSUKOS
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SATURN STREET
Mailing Address - Street 2:E207
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477
Mailing Address - Country:US
Mailing Address - Phone:561-379-7338
Mailing Address - Fax:
Practice Address - Street 1:1320 SE FEDERAL HWY STE 105
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3409
Practice Address - Country:US
Practice Address - Phone:772-444-7388
Practice Address - Fax:772-444-7388
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11706101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor