Provider Demographics
NPI:1801387543
Name:KOLB, HEATHER RAE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:KOLB
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COURT ST. SUITE 42
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST. SUITE 42
Practice Address - Street 2:
Practice Address - City:NORIWCH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102356-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker