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General NPI Number Information
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NPI Number | 1306724430
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Entity Type | Organization
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Legal Business Name | COLBERT PSYCHOTHERAPY & CONSULTING, INC.
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 255 S 17TH ST STE 2121
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City | PHILADELPHIA
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State | PA
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Zip | 19103-6211
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Country | US
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Telephone | 530-830-2558
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Fax |
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Provider Business Mailing Address
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Address Line | 4815 BEAUMONT AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19143-3407
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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 | OWNER
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Name | DR. SAMUEL MAX COLBERT
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Credential | PHD
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Telephone | 516-698-0174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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