Provider Demographics
NPI:1326782574
Name:LAROSILIERE AUPONT, KENYA MICHELLE
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:MICHELLE
Last Name:LAROSILIERE AUPONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAIROBI
Other - Middle Name:MICHELLE
Other - Last Name:AUPONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1081 OAK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1081 OAK ST
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3716
Practice Address - Country:US
Practice Address - Phone:188-872-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician