Provider Demographics
NPI:1316580111
Name:GRAFFITTI, KAYLENE-LYNN CHRISTINA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAYLENE-LYNN
Middle Name:CHRISTINA
Last Name:GRAFFITTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KAYLENE-LYNN
Other - Middle Name:CHRISTINA
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:430 SILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11980
Mailing Address - Country:US
Mailing Address - Phone:631-924-5583
Mailing Address - Fax:631-924-5687
Practice Address - Street 1:430 SILLS ROAD
Practice Address - Street 2:
Practice Address - City:YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11980
Practice Address - Country:US
Practice Address - Phone:631-924-5583
Practice Address - Fax:631-924-5687
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105827-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker