Provider Demographics
NPI:1871091827
Name:LUETTCHAU, KAYLIN ANNE
Entity type:Individual
Prefix:MRS
First Name:KAYLIN
Middle Name:ANNE
Last Name:LUETTCHAU
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAYLIN
Other - Middle Name:ANNE
Other - Last Name:DESANTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3712 GRAHAM CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3530
Mailing Address - Country:US
Mailing Address - Phone:908-448-7699
Mailing Address - Fax:
Practice Address - Street 1:540 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2405
Practice Address - Country:US
Practice Address - Phone:908-722-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06317200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker