Healthcare Provider Details

I. General information

NPI: 1558259044
Provider Name (Legal Business Name): KYLE ANDREW STRAUB LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 S 5TH AVE STE 102
CLARION PA
16214-8676
US

IV. Provider business mailing address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

V. Phone/Fax

Practice location:
  • Phone: 814-538-1779
  • Fax:
Mailing address:
  • Phone: 814-262-0025
  • Fax: 814-266-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: