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General NPI Number Information
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NPI Number | 1487120770
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Entity Type | Individual
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Provider Name | KAYLENE IRIZARRY PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 01/15/2023
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Provider Practice Location Address
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Address Line | 819 SOUTHWESTERN RUN # 2
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City | POLAND
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State | OH
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Zip | 44514-3688
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Country | US
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Telephone | 330-953-1354
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Fax | 330-953-1364
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | POLAND
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State | OH
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Zip | 44514-0545
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Country | US
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Telephone | 330-953-1354
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Fax | 330-953-1364
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00371900
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C.2103689
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P.08428
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License Number State | OH
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