Provider Demographics
NPI:1912519992
Name:KUDRAVITSKY, KAITLYN MARY (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARY
Last Name:KUDRAVITSKY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARY
Other - Last Name:GILMARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAC, NCC
Mailing Address - Street 1:4345 U.S. HIGHWAY 9 STE 7
Mailing Address - Street 2:#1014
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 KRESSON RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3227
Practice Address - Country:US
Practice Address - Phone:888-687-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00975700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional