Kaitlin M Petrillo, CLC
Lactation Consultant, Non-RN in Ronkonkoma, NY. Individual provider (NPI-1).
NPI number1558090860
StatusActive
Last updated in NPPESAug 22, 2022
Details
- NPI
- 1558090860
- Entity type
- Individual (NPI-1)
- Name
- Kaitlin M Petrillo
- Credential
- CLC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 10, 2022
- Certification date
- Aug 22, 2022
- Last updated
- Aug 22, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174N00000X | Lactation Consultant, Non-RN | 341362 | NY | Yes |
| 101Y00000X | Counselor | 341362 | MA |
Practice location
18 Borman CtRonkonkoma, NY 11779-1981
Phone 631-219-4992
Mailing address
18 Borman CtRonkonkoma, NY 11779-1981
Phone 631-219-4992
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