Provider Demographics
NPI:1669293247
Name:KODAMA MUSCENTE, KAILEE RYOKO (MA, MED)
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:RYOKO
Last Name:KODAMA MUSCENTE
Suffix:
Gender:F
Credentials:MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WILFRED ST
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5809
Mailing Address - Country:US
Mailing Address - Phone:626-372-3562
Mailing Address - Fax:
Practice Address - Street 1:246 GREENE ST.
Practice Address - Street 2:KIMBALL HALL, 5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-998-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling