Provider Demographics
NPI:1891728283
Name:DEVAULT, KRYSTAL JEAN (LCSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:JEAN
Last Name:DEVAULT
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:JEAN
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LISW
Mailing Address - Street 1:202 LYTLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16145-3112
Mailing Address - Country:US
Mailing Address - Phone:412-215-9417
Mailing Address - Fax:
Practice Address - Street 1:202 LYTLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SANDY LAKE
Practice Address - State:PA
Practice Address - Zip Code:16145-3112
Practice Address - Country:US
Practice Address - Phone:412-215-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801346104100000X
PACW0157061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker