Provider Demographics
NPI:1487120770
Name:IRIZARRY, KAYLENE (PSYD)
Entity type:Individual
Prefix:
First Name:KAYLENE
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0545
Mailing Address - Country:US
Mailing Address - Phone:330-953-1354
Mailing Address - Fax:330-953-1364
Practice Address - Street 1:819 SOUTHWESTERN RUN # 2
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3688
Practice Address - Country:US
Practice Address - Phone:330-953-1354
Practice Address - Fax:330-953-1364
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37AC00371900101YM0800X
OHC.2103689101YM0800X
OHP.08428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health