Provider Demographics
NPI:1245815083
Name:JURCZENKO, KYRYLICE (LCSW)
Entity type:Individual
Prefix:
First Name:KYRYLICE
Middle Name:
Last Name:JURCZENKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MCKNIGHT PARK DR STE 502A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-6517
Mailing Address - Country:US
Mailing Address - Phone:412-368-2205
Mailing Address - Fax:
Practice Address - Street 1:500 MCKNIGHT PARK DR STE 502A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6517
Practice Address - Country:US
Practice Address - Phone:412-368-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0216851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical