Provider Demographics
NPI:1700639549
Name:HORNER, KAYLA MAE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MAE
Last Name:HORNER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4618
Mailing Address - Country:US
Mailing Address - Phone:207-671-9818
Mailing Address - Fax:
Practice Address - Street 1:420 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2823
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical