Provider Demographics
NPI:1174158984
Name:MULLETT, KATHRYN ANN
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:MULLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MULLETT
Other - Last Name:FITZSIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:25 LINDSLEY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4456
Mailing Address - Country:US
Mailing Address - Phone:973-998-7900
Mailing Address - Fax:973-998-7910
Practice Address - Street 1:25 LINDSLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-998-7900
Practice Address - Fax:973-998-7910
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00967200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1881936847OtherNPI