Healthcare Provider Details

I. General information

NPI: 1427911858
Provider Name (Legal Business Name): MRS. KAITLYN WILLSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN IVANCIC

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E CROSS ST
CROTON FALLS NY
10519-7018
US

IV. Provider business mailing address

71 CLARK ST UNIT 123
TRENTON NJ
08611-1852
US

V. Phone/Fax

Practice location:
  • Phone: 716-799-9308
  • Fax:
Mailing address:
  • Phone: 716-799-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129024-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: