Provider Demographics
NPI:1538744727
Name:COLASURDO, KAITLYN ROSE (MS, LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROSE
Last Name:COLASURDO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ROSE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAC
Mailing Address - Street 1:PO BOX 3165
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-6165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 RIVER ST STE 9
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5990
Practice Address - Country:US
Practice Address - Phone:646-453-6777
Practice Address - Fax:212-337-9841
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00964800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health