Healthcare Provider Details

I. General information

NPI: 1215517206
Provider Name (Legal Business Name): KAYLAS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

IV. Provider business mailing address

41 SHELDON DR
MONTICELLO NY
12701-4122
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: RENEE GREEN
Title or Position: CEO
Credential: LMHC
Phone: 845-513-5754