Provider Demographics
NPI:1144738816
Name:KAYLAS PLACE
Entity Type:Organization
Organization Name:KAYLAS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LHMC
Authorized Official - Phone:845-513-5754
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-0699
Mailing Address - Country:US
Mailing Address - Phone:845-513-5754
Mailing Address - Fax:914-292-3422
Practice Address - Street 1:41 SHELDON DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-4122
Practice Address - Country:US
Practice Address - Phone:845-513-5754
Practice Address - Fax:914-292-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
007808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty