Individual
KAYLA A DEVITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
333 E MILLER DR, BLOOMINGTON, IN 47401-6557
(812) 353-3234
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33008618A
—
1041C0700X
Clinical Social Worker
Primary
34009361A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300064390
—
IN
01
—
940110070
MEDICARE PTAN
IN
Enumeration date
09/25/2018
Last updated
06/07/2023
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