Provider Demographics
NPI:1144309592
Name:PORNELUZI, KEVIN R (LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:PORNELUZI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-4265
Mailing Address - Country:US
Mailing Address - Phone:724-287-4196
Mailing Address - Fax:
Practice Address - Street 1:365 FRANKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8921
Practice Address - Country:US
Practice Address - Phone:724-543-1888
Practice Address - Fax:724-543-1898
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical