Provider Demographics
NPI:1194018051
Name:COLBERT, EVAN (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:COLBERT
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 GAR HWY UNIT 501
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-7722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-2406
Practice Address - Country:US
Practice Address - Phone:085-916-6839
Practice Address - Fax:508-804-7153
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL71081041C0700X
MA1202931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical