Provider Demographics
NPI:1922743277
Name:KAVANSHANSKY, KIM ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:KAVANSHANSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ANN
Other - Last Name:SCHUESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:24 LOCH LOMOND ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4067
Mailing Address - Country:US
Mailing Address - Phone:724-984-2494
Mailing Address - Fax:
Practice Address - Street 1:24 LOCH LOMOND ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4067
Practice Address - Country:US
Practice Address - Phone:724-984-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0223341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty