Provider Demographics
NPI:1952577355
Name:GARNON, KIM (MA)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:GARNON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 GLENRUADH AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1733
Mailing Address - Country:US
Mailing Address - Phone:814-392-9440
Mailing Address - Fax:814-455-5656
Practice Address - Street 1:1741 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1256
Practice Address - Country:US
Practice Address - Phone:814-392-9440
Practice Address - Fax:814-455-5656
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health