Provider Demographics
NPI:1528740685
Name:BLACK, KATELYNN HANNAH (LSW)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:HANNAH
Last Name:BLACK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:HANNAH
Other - Last Name:FINNEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1024 RIDGEBACK RD
Mailing Address - Street 2:
Mailing Address - City:GRINDSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:15442-1060
Mailing Address - Country:US
Mailing Address - Phone:724-833-5740
Mailing Address - Fax:
Practice Address - Street 1:2787 MEMORIAL BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1422
Practice Address - Country:US
Practice Address - Phone:724-603-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PASW1377141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker