Healthcare Provider Details

I. General information

NPI: 1023613593
Provider Name (Legal Business Name): ALIYA S KENYATTA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHEW ST
ALLENTOWN PA
18104-5586
US

IV. Provider business mailing address

105 REYNOLDS RD
ALBRIGHTSVILLE PA
18210-7009
US

V. Phone/Fax

Practice location:
  • Phone: 484-664-3178
  • Fax:
Mailing address:
  • Phone: 570-460-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW137669
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW137669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: