Provider Demographics
NPI:1215606215
Name:ALBUNIO, KYLIE ANDRA
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANDRA
Last Name:ALBUNIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-7749
Mailing Address - Country:US
Mailing Address - Phone:570-234-6807
Mailing Address - Fax:
Practice Address - Street 1:1056 PA-390
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326
Practice Address - Country:US
Practice Address - Phone:570-213-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1384231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical