Provider Demographics
NPI:1548315641
Name:KYLES-HARVEY, PEARLENE MARIE (MSW)
Entity type:Individual
Prefix:
First Name:PEARLENE
Middle Name:MARIE
Last Name:KYLES-HARVEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5397
Mailing Address - Country:US
Mailing Address - Phone:260-385-0713
Mailing Address - Fax:260-422-8783
Practice Address - Street 1:2200 LAKE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5397
Practice Address - Country:US
Practice Address - Phone:260-385-0713
Practice Address - Fax:260-422-8783
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker