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NPI Code Detail

MEDICARE: MR. JUSTIN COLWELL LCSW

MEDICARE: MR. JUSTIN COLWELL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerCA
21041C0700XClinical Social Worker108254CA
3171M00000XCase Manager/Care CoordinatorCA
4225400000XRehabilitation Practitioner
51041C0700XClinical Social WorkerLCSW108254CA

General Provider Information

NPI Number : 1033577531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN COLWELL LCSW
Provider Business Mailing Address
First Line : 217 W 64TH PL
Second Line :
City : INGLEWOOD
State : CA
Zip : 90302-1131
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1605 JEFFERSON ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1215
Country : US
Telephone Number : 510-923-1099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2016
Last Update Date : 07/07/2025

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