Provider Demographics
NPI:1093736886
Name:COLE, MARY JEAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY JEAN
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-5427
Mailing Address - Country:US
Mailing Address - Phone:610-435-9651
Mailing Address - Fax:610-435-9654
Practice Address - Street 1:52 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5948
Practice Address - Country:US
Practice Address - Phone:610-867-3946
Practice Address - Fax:610-867-3948
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003349L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01091901OtherCAPITAL BLUE CROSS PIN
0475445000OtherAMERIHEALTH PIN
4297241OtherAETNA PIN
644679KBXMedicare PIN