Provider Demographics
NPI:1124503289
Name:DEVITO, KAYLA A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:DEVITO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:A
Other - Last Name:MALOIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E MILLER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6557
Practice Address - Country:US
Practice Address - Phone:812-353-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
33008618A104100000X
IN34009361A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN940110070OtherMEDICARE PTAN
IN300064390Medicaid