Provider Demographics
NPI:1710547013
Name:DEBRA H. COLE, PH.D.
Entity Type:Organization
Organization Name:DEBRA H. COLE, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL CHILD PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-490-0075
Mailing Address - Street 1:1116 MILL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1078
Mailing Address - Country:US
Mailing Address - Phone:570-490-0075
Mailing Address - Fax:570-271-1995
Practice Address - Street 1:1116 MILL ST STE 102
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1078
Practice Address - Country:US
Practice Address - Phone:570-490-0075
Practice Address - Fax:570-271-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027911860001Medicaid