Provider Demographics
NPI:1790439107
Name:ESEMAYA, KAITLYNN IFECHUKWUDE
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:IFECHUKWUDE
Last Name:ESEMAYA
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 1:1303 GREENE AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4883
Mailing Address - Country:US
Mailing Address - Phone:570-581-0194
Mailing Address - Fax:
Practice Address - Street 1:107 W 82ND ST # P101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5511
Practice Address - Country:US
Practice Address - Phone:646-389-4112
Practice Address - Fax:212-500-0007
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician