Provider Demographics
NPI:1225904949
Name:VICENTE, KAYLAN (LMFT)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:
Last Name:VICENTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SCHUYLER AVE APT B22
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-4275
Mailing Address - Country:US
Mailing Address - Phone:914-564-9104
Mailing Address - Fax:
Practice Address - Street 1:700 SCHUYLER AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-4200
Practice Address - Country:US
Practice Address - Phone:914-564-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002581-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty