Provider Demographics
NPI:1275750614
Name:COBB-NETTLETON, CAROL A (DSW)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:COBB-NETTLETON
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 719
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1708
Mailing Address - Country:US
Mailing Address - Phone:610-971-9771
Mailing Address - Fax:610-971-0144
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 719
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1708
Practice Address - Country:US
Practice Address - Phone:610-971-9771
Practice Address - Fax:610-971-0144
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005959E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical