Provider Demographics
NPI:1114634201
Name:BLUMETTI, KAYLA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:BLUMETTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 WASHINGTON ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2405
Mailing Address - Country:US
Mailing Address - Phone:973-908-4272
Mailing Address - Fax:
Practice Address - Street 1:1581 ROUTE 23 STE 2
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7506
Practice Address - Country:US
Practice Address - Phone:973-435-6252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL068788001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical