Provider Demographics
NPI:1043442551
Name:KOHR, HEIDI L (LCSW)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:KOHR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E MAIN ST
Mailing Address - Street 2:SUITE 2, PMB 132
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078
Mailing Address - Country:US
Mailing Address - Phone:717-833-4898
Mailing Address - Fax:
Practice Address - Street 1:1335 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1117
Practice Address - Country:US
Practice Address - Phone:717-531-8338
Practice Address - Fax:717-531-6250
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PACW0177481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health