Healthcare Provider Details

I. General information

NPI: 1629769476
Provider Name (Legal Business Name): KAYLEE RAE LACALAMETO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date: 03/19/2025
Reactivation Date: 06/18/2025

III. Provider practice location address

9692 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45241-1071
US

IV. Provider business mailing address

9692 CINCINNATI COLUMBUS RD
WEST CHESTER OH
45241-1071
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-0080
  • Fax:
Mailing address:
  • Phone: 513-515-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.183307
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.003068
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2411673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: