Provider Demographics
NPI:1104589928
Name:ROSS, KYRA DAYNE (MHC-LP)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:DAYNE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462A QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-8150
Mailing Address - Country:US
Mailing Address - Phone:917-816-2728
Mailing Address - Fax:
Practice Address - Street 1:49 W 29TH ST STE 605
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4204
Practice Address - Country:US
Practice Address - Phone:347-987-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP100205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health