Provider Demographics
NPI:1104856483
Name:KYSOR, DANIEL F
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:F
Last Name:KYSOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1116
Mailing Address - Country:US
Mailing Address - Phone:814-642-7772
Mailing Address - Fax:814-642-2320
Practice Address - Street 1:10 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1116
Practice Address - Country:US
Practice Address - Phone:814-642-7772
Practice Address - Fax:814-642-2320
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007853L103T00000X
PA103TS0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015565270004Medicaid
PA2077161OtherCIGNA
PA513957OtherBCBS
PA513957OtherBCBS
PA2077161OtherCIGNA