Provider Demographics
NPI:1619639671
Name:DANEL, KERRY LYNN (MED)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:LYNN
Last Name:DANEL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-8422
Mailing Address - Country:US
Mailing Address - Phone:814-485-3486
Mailing Address - Fax:
Practice Address - Street 1:190 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-8422
Practice Address - Country:US
Practice Address - Phone:814-485-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA87-1987683OtherIRS