Provider Demographics
NPI:1649047861
Name:BERLOVAN, KAILA
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:BERLOVAN
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 1:115 15TH ST APT A2
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1508
Mailing Address - Country:US
Mailing Address - Phone:516-514-9814
Mailing Address - Fax:
Practice Address - Street 1:115 15TH ST APT A2
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1508
Practice Address - Country:US
Practice Address - Phone:516-514-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician