Healthcare Provider Details

I. General information

NPI: 1053106344
Provider Name (Legal Business Name): KAITLIN KAYLA PABUSTAN VILORIA-ELLORIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2060
APO AP
96278-2060
US

IV. Provider business mailing address

PSC 3 BOX 8008
APO AP
96266-0081
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-2148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352000935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: