Provider Demographics
NPI:1073263034
Name:CALISE, KYLE (ADCA)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:CALISE
Suffix:
Gender:M
Credentials:ADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1203
Mailing Address - Country:US
Mailing Address - Phone:207-454-1300
Mailing Address - Fax:207-454-1332
Practice Address - Street 1:12 BEECH ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1203
Practice Address - Country:US
Practice Address - Phone:207-454-1300
Practice Address - Fax:207-454-1332
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAD7442Medicaid