Individual
KAITLYNN B. CORNELL-MULLANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAT, RDT, MA
Contact information
Practice address
802 SENECA AVE APT 3L, RIDGEWOOD, NY 11385-4810
(845) 901-2799
Mailing address
802 SENECA AVE APT 3L, RIDGEWOOD, NY 11385-4810
(845) 901-2799
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
Primary
002579
NY
101YM0800X
Mental Health Counselor
002579
NY
221700000X
Art Therapist
002579
NY
Other
Enumeration date
05/04/2021
Last updated
05/08/2024
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