Provider Demographics
NPI:1457243420
Name:MAHNER, LOLA ISABELLA (LCSW)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:ISABELLA
Last Name:MAHNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-1831
Mailing Address - Country:US
Mailing Address - Phone:251-401-2273
Mailing Address - Fax:
Practice Address - Street 1:1004 W 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2208
Practice Address - Country:US
Practice Address - Phone:812-489-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011689A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical