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General NPI Number Information
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NPI Number | 1154542587
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Entity Type | Individual
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Provider Name | KYLE JOSEPH GILRAIN LICSW
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 570 MEMORIAL CIR STE 310
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5060
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Country | US
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Telephone | 386-290-2993
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Fax |
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Provider Business Mailing Address
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Address Line | 570 MEMORIAL CIR STE 310
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5060
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Country | US
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Telephone | 386-290-2993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09004006701
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License Number State | FL
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