Healthcare Provider Details

I. General information

NPI: 1699214080
Provider Name (Legal Business Name): KAYLA MARIE DILORENZO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OAKLEY STREET
POUGHKEEPSIE NY
12601
US

IV. Provider business mailing address

209 OLD ROUTE 9 STE 5
FISHKILL NY
12524-2476
US

V. Phone/Fax

Practice location:
  • Phone: 845-240-7707
  • Fax: 845-337-3678
Mailing address:
  • Phone: 845-875-7133
  • Fax: 845-875-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: