Provider Demographics
NPI:1215775606
Name:MAISONAVE, KAYLA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:MAISONAVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5227
Mailing Address - Country:US
Mailing Address - Phone:631-697-8229
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVE FL 17
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7595
Practice Address - Country:US
Practice Address - Phone:212-633-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123760104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker