Individual
KAITLIN M PETRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
18 BORMAN CT, RONKONKOMA, NY 11779-1981
(631) 219-4992
Mailing address
18 BORMAN CT, RONKONKOMA, NY 11779-1981
(631) 219-4992
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
341362
MA
174N00000X
Lactation Consultant (Non-RN)
Primary
341362
NY
Other
Enumeration date
06/10/2022
Last updated
08/22/2022
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