Provider Demographics
NPI:1740239664
Name:BAKUHN, AUDREY MARY (MSSA, LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARY
Last Name:BAKUHN
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 FAYETTE NEW WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-4608
Mailing Address - Country:US
Mailing Address - Phone:724-946-9710
Mailing Address - Fax:724-946-9710
Practice Address - Street 1:2201 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2727
Practice Address - Country:US
Practice Address - Phone:724-981-7141
Practice Address - Fax:724-981-7148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050801F4RMedicare ID - Type UnspecifiedIN ASSOCIATION WITH CCC
PAS22448Medicare UPIN