Provider Demographics
NPI:1760993075
Name:CLINTON, KYLANA
Entity type:Individual
Prefix:
First Name:KYLANA
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1011
Mailing Address - Country:US
Mailing Address - Phone:908-512-6100
Mailing Address - Fax:
Practice Address - Street 1:20 MAPLE RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1011
Practice Address - Country:US
Practice Address - Phone:908-512-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2025-08-19
Deactivation Date:2021-02-02
Deactivation Code:
Reactivation Date:2025-08-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician