Provider Demographics
NPI:1699405860
Name:PULLICINO, KATHRYN ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:PULLICINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:KIRKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:6335 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7112
Mailing Address - Country:US
Mailing Address - Phone:317-780-1610
Mailing Address - Fax:
Practice Address - Street 1:6335 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7112
Practice Address - Country:US
Practice Address - Phone:317-780-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043525A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20043525AOtherINDIANA STATE PSYCHOLOGY BOARD