Provider Demographics
NPI:1326481235
Name:DECARR, KAYLA (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:DECARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:J
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1427 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4343
Mailing Address - Country:US
Mailing Address - Phone:315-738-1428
Mailing Address - Fax:315-733-7105
Practice Address - Street 1:1427 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4343
Practice Address - Country:US
Practice Address - Phone:315-738-1428
Practice Address - Fax:315-733-7105
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086126-1104100000X
NY085246-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03579628Medicaid
NY01039156Medicaid