Provider Demographics
NPI:1902963127
Name:KENYON, ANNE VIRGINIA (LSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:VIRGINIA
Last Name:KENYON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:VIRGINIA
Other - Last Name:KENYON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:444 E COLLEGE AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5558
Mailing Address - Country:US
Mailing Address - Phone:814-231-0940
Mailing Address - Fax:814-231-4702
Practice Address - Street 1:444 E COLLEGE AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5558
Practice Address - Country:US
Practice Address - Phone:814-231-0940
Practice Address - Fax:814-231-4702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002872101YP2500X
PASW004567E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1722717Medicaid
PA2106024OtherCIGNA
PA342657OtherMHN
PA394700OtherVALUE OPTIONS
PA2106024OtherCIGNA