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Kathryn Mary Lyle, LGSW

Individual provider Active NPI Clinical Social Worker · Kearneysville, WV

NPI 1740933282 · NPPES record last updated Oct 3, 2022

Key facts

NPI
1740933282
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
BP00946159 (WV)
Practice address
179 E Burr Blvd Ste L
Kearneysville, WV 25430-4964
Phone
(304) 268-5330
NPI assigned
Feb 3, 2022
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SW112116078WVMDMental Health Counselor
BP00946159WVMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Hidden Peaces LLC Past
since Oct 9, 2022		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X SW112116078 WV
Clinical Social Worker 1041C0700X BP00946159 WV Yes

Addresses

Primary practice location

179 E Burr Blvd Ste L
Kearneysville, WV 25430-4964

Mailing address

632 Rudder Rd
Shepherdstown, WV 25443-4239
Phone (843) 957-1034

Other providers in Kearneysville, WV

All providers in Kearneysville, WV · Clinical Social Worker in West Virginia

Sources for this page

Verify at the official NPI Registry.