Provider Demographics
NPI:1245651991
Name:KEPHART, BRIAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:KEPHART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4459
Mailing Address - Country:US
Mailing Address - Phone:724-980-2229
Mailing Address - Fax:
Practice Address - Street 1:5274 STATE ROUTE 30 STE 10
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7831
Practice Address - Country:US
Practice Address - Phone:724-216-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-25
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0177441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1245651991Medicare NSC