MEDICARE: KAITLYN PRY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW019328	PA

General Provider Information

NPI Number	:	1699211235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN PRY LCSW

Provider Business Mailing Address
First Line	:	3057 TEXAS AVE
Second Line	:	FL 2
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 WASHINGTON RD STE TL6
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1926
Country	:	US
Telephone Number	:	412-561-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	08/08/2024

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Directions to “ KAITLYN PRY LCSW” Practice Location

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