Provider Demographics
NPI:1669988200
Name:NISLY, LYNETTE MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MARIE
Last Name:NISLY
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:COBYS FAMILY SERVICES
Mailing Address - Street 2:1417 OREGON ROAD
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540
Mailing Address - Country:US
Mailing Address - Phone:717-661-3548
Mailing Address - Fax:717-656-3056
Practice Address - Street 1:1417 OREGON RD
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-9754
Practice Address - Country:US
Practice Address - Phone:717-661-3548
Practice Address - Fax:717-656-3056
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128091104100000X
PACW0211731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker