Provider Demographics
NPI:1275333213
Name:GIL, KYRA ANN (LAC)
Entity type:Individual
Prefix:MISS
First Name:KYRA
Middle Name:ANN
Last Name:GIL
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 RACHEL TER APT 2
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058-9342
Mailing Address - Country:US
Mailing Address - Phone:973-767-7905
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1433
Practice Address - Country:US
Practice Address - Phone:973-845-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00636700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor