Provider Demographics
NPI:1720671241
Name:LIVELY, CORAL
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:LIVELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORAL
Other - Middle Name:
Other - Last Name:CONSYLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-5040
Mailing Address - Country:US
Mailing Address - Phone:717-272-5464
Mailing Address - Fax:717-376-1712
Practice Address - Street 1:6079 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1267
Practice Address - Country:US
Practice Address - Phone:855-272-1653
Practice Address - Fax:717-376-1712
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor