Provider Demographics
NPI:1073267811
Name:BRACE, KAYLAH MARIE
Entity Type:Individual
Prefix:
First Name:KAYLAH
Middle Name:MARIE
Last Name:BRACE
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 1:14 LANCASTER ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2688
Mailing Address - Country:US
Mailing Address - Phone:508-733-4685
Mailing Address - Fax:
Practice Address - Street 1:14 LANCASTER ST APT 3L
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2688
Practice Address - Country:US
Practice Address - Phone:508-733-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health