Provider Demographics
NPI:1780256024
Name:KOLBA, CAITLIN E (LSW)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:E
Last Name:KOLBA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 DELONG AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-2839
Mailing Address - Country:US
Mailing Address - Phone:540-522-9273
Mailing Address - Fax:
Practice Address - Street 1:2132 S 12TH ST STE 402
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4810
Practice Address - Country:US
Practice Address - Phone:484-350-3001
Practice Address - Fax:484-350-4811
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138275104100000X
PACW0243171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker