Provider Demographics
NPI:1154713485
Name:ANDERS, KATHRYN MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELLE
Last Name:ANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MICHELLE
Other - Last Name:HARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:119 S BURROWES ST STE 706
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3864
Mailing Address - Country:US
Mailing Address - Phone:814-753-1071
Mailing Address - Fax:814-775-2413
Practice Address - Street 1:103 E BEAVER AVE STE 2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4969
Practice Address - Country:US
Practice Address - Phone:814-409-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131549104100000X
PACW0206461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker