Provider Demographics
NPI:1972184448
Name:GRAY, KYLA (MSW, LSW, ACM-SW)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW, LSW, ACM-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BOYDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:16061-2204
Mailing Address - Country:US
Mailing Address - Phone:724-355-8785
Mailing Address - Fax:
Practice Address - Street 1:353 N DUFFY RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1138
Practice Address - Country:US
Practice Address - Phone:800-362-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136865104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker