Provider Demographics
NPI:1740035856
Name:KOLODY, DANIELLE (MS LBS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KOLODY
Suffix:
Gender:F
Credentials:MS LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:DORNSIFE
Mailing Address - State:PA
Mailing Address - Zip Code:17823-7260
Mailing Address - Country:US
Mailing Address - Phone:570-490-5688
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6516
Practice Address - Fax:570-271-5814
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005123103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst