Basic Information
| Provider Information | |||||||||
| NPI: | 1730832734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GALLUCCI | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | TARA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 CHURCH ST APT 4 | ||||||||
| Address2: | |||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125611505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457061474 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 GRAND ST | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455627244 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2022 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 113763 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.