Provider Demographics
NPI:1992407159
Name:SIDER, KAYLEY ANNE (MSW)
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:ANNE
Last Name:SIDER
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 1:4906 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1978
Mailing Address - Country:US
Mailing Address - Phone:814-864-4226
Mailing Address - Fax:
Practice Address - Street 1:4906 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1978
Practice Address - Country:US
Practice Address - Phone:814-864-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor