Active NPI
Daniel F Kysor
- Clinical Social Worker
- Port Allegany, PA
National Provider Identifier
1104856483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 10 Church St
Port Allegany, PA 16743-1116 - Phone
- (814) 642-7772
- Fax
- (814) 642-2320
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS007853L | PA | |
| School Psychologist | 103TS0200X | PA | ||
| Clinical Social Worker | 1041C0700X | PA | Primary |
Addresses
Primary practice location
10 Church St
Port Allegany, PA 16743-1116
Mailing address
10 Church St
Port Allegany, PA 16743-1116
Phone (814) 642-7772
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0015565270004 | Medicaid | PA | |
| 2077161 | Other | PA | CIGNA |
| 513957 | Other | PA | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS007853L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1104856483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CHURCH ST",
"city": "PORT ALLEGANY",
"state": "PA",
"postal_code": "167431116",
"telephone_number": "814-642-7772",
"fax_number": "814-642-2320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 CHURCH ST",
"city": "PORT ALLEGANY",
"state": "PA",
"postal_code": "167431116",
"telephone_number": "814-642-7772",
"fax_number": "814-642-2320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KYSOR",
"first_name": "DANIEL",
"middle_name": "F",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS007853L",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "PA",
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0015565270004",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2077161",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "513957",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Allegany, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.