Healthcare Provider Details

I. General information

NPI: 1245303072
Provider Name (Legal Business Name): KIMBERLY HUNT LANDA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANNE HUNT LSW

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 PELLIS RD SUITE 101 TIMOTHY BRIDGES PHD AND ASSOCIATES INC
GREENSBURG PA
15601
US

IV. Provider business mailing address

438 PELLIS RD SUITE 101 TIMOTHY BRIDGES PHD AND ASSOCIATES INC
GREENSBURG PA
15601
US

V. Phone/Fax

Practice location:
  • Phone: 724-850-7448
  • Fax: 724-850-8143
Mailing address:
  • Phone: 724-850-7448
  • Fax: 724-850-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014296
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: