Provider Demographics
NPI:1386005171
Name:KOLB LYONS, MANDY SUE (BSW, MS)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:SUE
Last Name:KOLB LYONS
Suffix:
Gender:F
Credentials:BSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:405 SILVER MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9803
Mailing Address - Country:US
Mailing Address - Phone:717-495-0136
Mailing Address - Fax:
Practice Address - Street 1:405 SILVER MAPLE CT
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9803
Practice Address - Country:US
Practice Address - Phone:717-495-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No104100000XBehavioral Health & Social Service ProvidersSocial Worker