Provider Demographics
NPI:1457716912
Name:TROY, JOLANTAS STANISLAWA
Entity Type:Individual
Prefix:
First Name:JOLANTAS
Middle Name:STANISLAWA
Last Name:TROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOLANTA
Other - Middle Name:STANISLAWA
Other - Last Name:TROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSC
Mailing Address - Street 1:40 BEARS SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-8999
Mailing Address - Country:US
Mailing Address - Phone:717-681-5076
Mailing Address - Fax:
Practice Address - Street 1:816 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4001
Practice Address - Country:US
Practice Address - Phone:717-243-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst