Provider Demographics
NPI:1013524784
Name:IACOMINI, KAITLIN MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIA
Last Name:IACOMINI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7157
Mailing Address - Country:US
Mailing Address - Phone:845-489-1447
Mailing Address - Fax:
Practice Address - Street 1:26 OAKLEY ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2005
Practice Address - Country:US
Practice Address - Phone:888-750-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP106987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker