Provider Demographics
NPI:1801508551
Name:SIMMONS, LAC, KAYLA N
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:N
Last Name:SIMMONS, LAC
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 1:10 BREVOORT PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1812
Mailing Address - Country:US
Mailing Address - Phone:917-554-4939
Mailing Address - Fax:
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD STE 202
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:732-982-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1801508551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health