Provider Demographics
NPI:1285019414
Name:KOLODNY, PEGGY LEE (MA ATR-BC LCPAT)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LEE
Last Name:KOLODNY
Suffix:
Gender:F
Credentials:MA ATR-BC LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2700
Mailing Address - Country:US
Mailing Address - Phone:410-292-4848
Mailing Address - Fax:410-357-3699
Practice Address - Street 1:10806 REISTERSTOWN RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2700
Practice Address - Country:US
Practice Address - Phone:410-292-4848
Practice Address - Fax:410-357-3699
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional