Krystal Jean Devault, LCSW, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW015706 Issued in PA

Practice address

202 Lytle School Rd
Sandy Lake, PA 16145-3112

Phone

(412) 215-9417

NPI assigned

Jul 8, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Krystal Jean Bradley Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1891728283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 LYTLE SCHOOL RD",
            "city": "SANDY LAKE",
            "state": "PA",
            "postal_code": "161453112",
            "telephone_number": "412-215-9417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 LYTLE SCHOOL RD",
            "city": "SANDY LAKE",
            "state": "PA",
            "postal_code": "161453112",
            "telephone_number": "412-215-9417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVAULT",
        "first_name": "KRYSTAL",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.1801346",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW015706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "BRADLEY",
            "middle_name": "JEAN",
            "prefix": "MS.",
            "credential": "LCSW, LISW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Social Worker in Sandy Lake, PA
• Providers in Sandy Lake, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.