Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | PC007743 | PA |
NPI | 1003395005 |
---|---|
Provider Name | Mallory Lynn Kurnock |
First Address | Mckeesport, PA 15135-2203 |
Second Address | Mckeesport, PA 15135-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |