Provider Demographics
NPI:1659922367
Name:MCCRAY, KIA R (DSW, LSW)
Entity Type:Individual
Prefix:DR
First Name:KIA
Middle Name:R
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:DSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W 7TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-1333
Mailing Address - Country:US
Mailing Address - Phone:474-484-0714
Mailing Address - Fax:
Practice Address - Street 1:502 W 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1333
Practice Address - Country:US
Practice Address - Phone:474-484-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2022-07-20
Deactivation Date:2020-03-02
Deactivation Code:
Reactivation Date:2021-02-26
Provider Licenses
StateLicense IDTaxonomies
PASW136522104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker