Provider Demographics
NPI:1891155735
Name:VANGUILDER, KAYLA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:VANGUILDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 GROVER AVE W
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3233
Mailing Address - Country:US
Mailing Address - Phone:518-527-5434
Mailing Address - Fax:
Practice Address - Street 1:208 GROVER AVE W
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762
Practice Address - Country:US
Practice Address - Phone:518-527-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP98257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health