Provider Demographics
NPI:1639888076
Name:KYLE, KENNETH C
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:KYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PELHAM RD APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3119
Mailing Address - Country:US
Mailing Address - Phone:718-864-2891
Mailing Address - Fax:
Practice Address - Street 1:126 LIBRARY LN
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3608
Practice Address - Country:US
Practice Address - Phone:914-670-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician