Provider Demographics
NPI:1538608088
Name:KOLB, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHALK POND RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03221-6712
Mailing Address - Country:US
Mailing Address - Phone:508-863-9195
Mailing Address - Fax:
Practice Address - Street 1:718 SMYTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7007
Practice Address - Country:US
Practice Address - Phone:508-863-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2025-02-12
Deactivation Date:2018-05-23
Deactivation Code:
Reactivation Date:2023-05-02
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NH26921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical