Provider Demographics
NPI:1881326858
Name:STYCZYNSKI, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:STYCZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 HIGHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1032
Mailing Address - Country:US
Mailing Address - Phone:518-307-4846
Mailing Address - Fax:
Practice Address - Street 1:5180 CAMPBELLS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9731
Practice Address - Country:US
Practice Address - Phone:518-307-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health