Provider Demographics
NPI:1487044467
Name:COFER, TYLYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TYLYNN
Middle Name:
Last Name:COFER
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 1:6034 HAMILTON BLVD
Mailing Address - Street 2:PMB 1060
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106
Mailing Address - Country:US
Mailing Address - Phone:484-488-7989
Mailing Address - Fax:
Practice Address - Street 1:6034 HAMILTON BLVD
Practice Address - Street 2:PMB 1060
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:484-488-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0188251041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW018825OtherCLINICAL SOCIAL WORKER