1194552091 NPI number — MRS. KARYN LEIGH NOLL MALS, LMSW

Table of content: MRS. KARYN LEIGH NOLL MALS, LMSW (NPI 1194552091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194552091 NPI number — MRS. KARYN LEIGH NOLL MALS, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLL
Provider First Name:
KARYN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MALS, LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOTIKA
Provider Other First Name:
KARYN
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MALS, LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194552091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 NOBLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KUTZTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19530-9728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-538-9909
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22-24 N. FRANKLIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEETWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19522-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-944-0445
Provider Business Practice Location Address Fax Number:
610-944-8834
Provider Enumeration Date:
09/16/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW142078 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)