Provider Demographics
NPI:1245303072
Name:LANDA, KIMBERLY HUNT (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HUNT
Last Name:LANDA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:438 PELLIS RD SUITE 101
Mailing Address - Street 2:TIMOTHY BRIDGES PHD AND ASSOCIATES INC
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-850-7448
Mailing Address - Fax:724-850-8143
Practice Address - Street 1:438 PELLIS RD SUITE 101
Practice Address - Street 2:TIMOTHY BRIDGES PHD AND ASSOCIATES INC
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-850-7448
Practice Address - Fax:724-850-8143
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA910517OtherHIGHMARK BLUE CROSS BLUE