Provider Demographics
NPI:1558259044
Name:STRAUB, KYLE ANDREW (LSW)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:STRAUB
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 COLLEGE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2833
Mailing Address - Country:US
Mailing Address - Phone:814-262-0025
Mailing Address - Fax:814-266-2880
Practice Address - Street 1:1008 S 5TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8676
Practice Address - Country:US
Practice Address - Phone:814-538-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker