Provider Demographics
NPI:1457175085
Name:BERRY, KYLA LAUREN (LCAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:LAUREN
Last Name:BERRY
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5142 30TH AVE APT H3O
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7949
Mailing Address - Country:US
Mailing Address - Phone:516-426-3776
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3467
Practice Address - Country:US
Practice Address - Phone:718-901-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001987221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist