Provider Demographics
NPI:1457973620
Name:HUYCK, KIMBERLY ANN (LSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HUYCK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16443-0041
Mailing Address - Country:US
Mailing Address - Phone:814-397-9466
Mailing Address - Fax:
Practice Address - Street 1:22 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-1329
Practice Address - Country:US
Practice Address - Phone:814-462-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker