Healthcare Provider Details

I. General information

NPI: 1790727782
Provider Name (Legal Business Name): MR. KENT ZELLEFROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SHAW AVE
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

1113 HAMIL RD
VERONA PA
15147-2725
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-8850
  • Fax: 412-675-8452
Mailing address:
  • Phone: 412-798-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015985
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: