Provider Demographics
NPI:1801037056
Name:CSILLAG, KIM (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:CSILLAG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:CSILLAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:49 ISMAY ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5019
Mailing Address - Country:US
Mailing Address - Phone:718-698-1752
Mailing Address - Fax:
Practice Address - Street 1:49 ISMAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5019
Practice Address - Country:US
Practice Address - Phone:718-698-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058071104100000X, 171M00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist