Provider Demographics
NPI:1245007368
Name:CERVONI, KAYLA (MSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CERVONI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17911 BONITA NATIONAL BLVD UNIT 128
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8710
Mailing Address - Country:US
Mailing Address - Phone:860-301-5949
Mailing Address - Fax:
Practice Address - Street 1:10661 AIRPORT-PULLING RD
Practice Address - Street 2:STE 14
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34109
Practice Address - Country:US
Practice Address - Phone:239-383-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW165051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical