| Doctor Name: | MR. KENNETH MICHAEL LACILLA |
| NPI Number: | 1063627149 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | 004908 |
| Business Practice Address: | 476 Howe Ave Suite 4 Shelton, CT - 064843153 |
| Business Phone Number: | 2039249426 |
| Business Fax Number: | |
| Mailing Address: | 41 Appletree Ln, NORTH HAVEN |
| State: | CT |
| Postal Code: | 064732903 |
| Phone Number: | 2032887943 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 004908 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |