Provider Demographics
NPI:1083654818
Name:KIRK, ALYSIA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALYSIA
Middle Name:D
Last Name:KIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15129-8802
Mailing Address - Country:US
Mailing Address - Phone:412-721-2648
Mailing Address - Fax:
Practice Address - Street 1:39 WHITE AVE
Practice Address - Street 2:
Practice Address - City:CRAFTON
Practice Address - State:PA
Practice Address - Zip Code:15205-2847
Practice Address - Country:US
Practice Address - Phone:412-921-3549
Practice Address - Fax:412-922-3230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA246257OtherCOMP PSYCH
PA788901000OtherAETNA
PA1647712OtherHIGHMARK