Provider Demographics
NPI:1316669476
Name:CALABRESE, KAYLA JOAN
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JOAN
Last Name:CALABRESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ORBIT LN
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4452
Mailing Address - Country:US
Mailing Address - Phone:631-707-2547
Mailing Address - Fax:
Practice Address - Street 1:18 ORBIT LN
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4452
Practice Address - Country:US
Practice Address - Phone:631-707-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119285-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool