Provider Demographics
NPI:1740508027
Name:KUZILLA, JENNY (LCSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KUZILLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:WICKLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:147 THREE DEGREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2305
Mailing Address - Country:US
Mailing Address - Phone:412-537-9343
Mailing Address - Fax:
Practice Address - Street 1:30 MAPLE DR STE A
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8327
Practice Address - Country:US
Practice Address - Phone:412-537-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0166361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical