Healthcare Provider Details

I. General information

NPI: 1174431373
Provider Name (Legal Business Name): OLIVIA ROSE COLOMBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 FURNACE BROOK PKWY
QUINCY MA
02169-4758
US

IV. Provider business mailing address

17 SEAVER AVE
KINGSTON MA
02364-1614
US

V. Phone/Fax

Practice location:
  • Phone: 508-868-5463
  • Fax:
Mailing address:
  • Phone: 508-868-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW229556
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: