Healthcare Provider Details

I. General information

NPI: 1144738816
Provider Name (Legal Business Name): KAYLAS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

IV. Provider business mailing address

PO BOX 699
MONTICELLO NY
12701-0699
US

V. Phone/Fax

Practice location:
  • Phone: 845-513-5754
  • Fax: 914-292-3422
Mailing address:
  • Phone: 845-513-5754
  • Fax: 914-292-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007808
License Number State

VIII. Authorized Official

Name: RENEE GREEN
Title or Position: DIRECTOR
Credential: M.S., LHMC
Phone: 845-513-5754