=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275927493
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHY L. NAIL LCSW, MAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2015
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 E PITT ST SUITE/APT. 1
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15522-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-623-7370
-----------------------------------------------------
Fax | 814-623-7375
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 E PITT ST SUITE/APT. 1
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15522-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-623-7370
-----------------------------------------------------
Fax | 814-623-7375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW018470
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CW018470
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------