Provider Demographics
NPI:1730671819
Name:GULOTTA, JILL (MS, RDN, CDN, LP-MHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:MS, RDN, CDN, LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 DOBBS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1900
Mailing Address - Country:US
Mailing Address - Phone:914-610-0463
Mailing Address - Fax:
Practice Address - Street 1:280 DOBBS FERRY RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1900
Practice Address - Country:US
Practice Address - Phone:914-610-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY009396133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health