Healthcare Provider Details

I. General information

NPI: 1386363133
Provider Name (Legal Business Name): KAYLA ANNE MUGLIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WALLACE LN
BROOKHAVEN NY
11719-9753
US

IV. Provider business mailing address

6 WALLACE LN
BROOKHAVEN NY
11719-9753
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-2820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101190
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103797
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: