Provider Demographics
NPI:1013245901
Name:KOLB, MARY JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOY
Last Name:KOLB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5471
Mailing Address - Country:US
Mailing Address - Phone:240-252-4105
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5471
Practice Address - Country:US
Practice Address - Phone:240-252-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3578103K00000X
MD04764103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst