Provider Demographics
NPI:1124776695
Name:DUSEL, COLLEEN MARY (LICSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:DUSEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1618
Mailing Address - Country:US
Mailing Address - Phone:413-588-1560
Mailing Address - Fax:
Practice Address - Street 1:1992 OLD LOUISQUISSET PIKE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4590
Practice Address - Country:US
Practice Address - Phone:401-475-0653
Practice Address - Fax:401-475-0729
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW035041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical