Provider Demographics
NPI:1427911858
Name:WILLSEY, KAITLYN
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:WILLSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:IVANCIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:71 CLARK ST UNIT 123
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08611-1852
Mailing Address - Country:US
Mailing Address - Phone:716-799-9308
Mailing Address - Fax:
Practice Address - Street 1:3 E CROSS ST
Practice Address - Street 2:
Practice Address - City:CROTON FALLS
Practice Address - State:NY
Practice Address - Zip Code:10519-7018
Practice Address - Country:US
Practice Address - Phone:716-799-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129024-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical