Provider Demographics
NPI:1639234305
Name:BUGG, KYLE CALLIS II (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:CALLIS
Last Name:BUGG
Suffix:II
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:156 5TH AVE STE 822
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7765
Mailing Address - Country:US
Mailing Address - Phone:212-256-1697
Mailing Address - Fax:626-209-1194
Practice Address - Street 1:156 5TH AVE STE 822
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7765
Practice Address - Country:US
Practice Address - Phone:212-256-1697
Practice Address - Fax:646-792-3850
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical