Provider Demographics
NPI:1720951114
Name:GULOTTA, KAILEY KIEFF
Entity type:Individual
Prefix:MRS
First Name:KAILEY
Middle Name:KIEFF
Last Name:GULOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19374 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8813
Mailing Address - Country:US
Mailing Address - Phone:504-444-3647
Mailing Address - Fax:985-302-3584
Practice Address - Street 1:19374 N 3RD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8813
Practice Address - Country:US
Practice Address - Phone:504-444-3647
Practice Address - Fax:985-302-3584
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARBT-24-324646106S00000X
LAR-15342106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician