Provider Demographics
NPI:1760013841
Name:CLIFFORD, KAITLYN ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNA
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E 39TH ST STE 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0125
Mailing Address - Country:US
Mailing Address - Phone:631-517-0143
Mailing Address - Fax:
Practice Address - Street 1:6 E 39TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0112
Practice Address - Country:US
Practice Address - Phone:646-781-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096328104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker