MEDICARE: MS. ALICIA KOLBER L.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW010979L	PA

General Provider Information

NPI Number	:	1871828608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA KOLBER L.S.W.

Provider Business Mailing Address
First Line	:	85 OLD EAGLE SCHOOL RD
Second Line	:	SUITE 200
City	:	STRAFFORD
State	:	PA
Zip	:	19087-2556
Country	:	US
Telephone Number	:	610-688-1045
Fax Number	:	610-688-8632

Provider Business Practice Location Address
First Line	:	85 OLD EAGLE SCHOOL RD
Second Line	:	SUITE 200
City	:	STRAFFORD
State	:	PA
Zip	:	19087-2556
Country	:	US
Telephone Number	:	610-688-1045
Fax Number	:	610-688-8632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	10/13/2009

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