Provider Demographics
NPI:1063849974
Name:KILTS, KYLE ERICK (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ERICK
Last Name:KILTS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1491
Mailing Address - Country:US
Mailing Address - Phone:518-510-3100
Mailing Address - Fax:
Practice Address - Street 1:15 CORNELL RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1491
Practice Address - Country:US
Practice Address - Phone:518-510-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical