Individual
KAYLA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
319 E WATER ST, SYRACUSE, NY 13202-1123
(315) 475-1771
(315) 475-4601
Mailing address
319 EAST WATER STREET, SYRACUSE, NY 13202
(315) 475-1771
(315) 475-4601
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
32336
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271578278
—
NY
Enumeration date
03/21/2017
Last updated
03/21/2017
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