Provider Demographics
NPI:1699028654
Name:DELVAUX, KYLEE BAKER (LCSW)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:BAKER
Last Name:DELVAUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KYLEE
Other - Middle Name:NOELINE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5 MCHUGH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5236
Mailing Address - Country:US
Mailing Address - Phone:518-232-3468
Mailing Address - Fax:
Practice Address - Street 1:498 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2230
Practice Address - Country:US
Practice Address - Phone:518-480-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0906241041C0700X
NY1018191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101819Medicaid