Provider Demographics
NPI:1124880349
Name:WONG, KAYLA LELANI (PHD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LELANI
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 160TH ST APT 1K
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2503
Mailing Address - Country:US
Mailing Address - Phone:929-498-1318
Mailing Address - Fax:
Practice Address - Street 1:6576 160TH ST APT 1K
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2503
Practice Address - Country:US
Practice Address - Phone:929-498-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool