Provider Demographics
NPI:1376292383
Name:STEVENER, KYLENE MARY (LMSW)
Entity Type:Individual
Prefix:
First Name:KYLENE
Middle Name:MARY
Last Name:STEVENER
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 1:800 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2913
Mailing Address - Country:US
Mailing Address - Phone:315-679-1192
Mailing Address - Fax:
Practice Address - Street 1:800 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2913
Practice Address - Country:US
Practice Address - Phone:315-679-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114232-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker