Provider Demographics
NPI:1487340956
Name:MCLEAN, KAYLA JADE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JADE
Last Name:MCLEAN
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 1:16 WILKEN LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7515
Mailing Address - Country:US
Mailing Address - Phone:631-829-8253
Mailing Address - Fax:
Practice Address - Street 1:755 NEW YORK AVE STE 230
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4285
Practice Address - Country:US
Practice Address - Phone:631-572-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health