Provider Demographics
NPI:1316728421
Name:KOLB, CORRINE (LSW)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:KOLB
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 1:29 TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2943
Mailing Address - Country:US
Mailing Address - Phone:732-865-1503
Mailing Address - Fax:
Practice Address - Street 1:2 BENNINGTON PL
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5701
Practice Address - Country:US
Practice Address - Phone:732-309-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06673400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker