Provider Demographics
NPI:1356932941
Name:KULAKOFSKY, JUDITH C (LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:C
Last Name:KULAKOFSKY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:MIRIAM
Other - Last Name:CHARLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 HIGH MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2133
Mailing Address - Country:US
Mailing Address - Phone:860-874-8561
Mailing Address - Fax:
Practice Address - Street 1:304 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4355
Practice Address - Country:US
Practice Address - Phone:860-874-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist