Provider Demographics
NPI:1770342032
Name:YASIKA, KAITLIN ANNA (LMSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANNA
Last Name:YASIKA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DEER CT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6864
Mailing Address - Country:US
Mailing Address - Phone:845-492-1276
Mailing Address - Fax:
Practice Address - Street 1:305 NORTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4704
Practice Address - Country:US
Practice Address - Phone:845-492-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker