Healthcare Provider Details

I. General information

NPI: 1720732639
Provider Name (Legal Business Name): KAILEN LEMMINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 LAUREL AVE
EAST ISLIP NY
11730-1935
US

IV. Provider business mailing address

48 LAUREL AVE
EAST ISLIP NY
11730-1935
US

V. Phone/Fax

Practice location:
  • Phone: 631-872-5008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: