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General NPI Number Information
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NPI Number | 1194018051
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Entity Type | Individual
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Provider Name | EVAN COLBERT MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 11/23/2024
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Provider Practice Location Address
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Address Line | 442 WILBUR AVE
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City | SWANSEA
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State | MA
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Zip | 02777-2406
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Country | US
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Telephone | 85-916-6839
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Fax | 508-804-7153
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Provider Business Mailing Address
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Address Line | 1278 GAR HWY UNIT 501
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City | SWANSEA
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State | MA
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Zip | 02777-7722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L7108
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 120293
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License Number State | MA
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