Provider Demographics
NPI:1528743275
Name:EDWARDS, KAYLA (BSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1710
Mailing Address - Country:US
Mailing Address - Phone:631-294-7268
Mailing Address - Fax:
Practice Address - Street 1:770 GRAND BLVD STE 17
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5725
Practice Address - Country:US
Practice Address - Phone:631-392-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical