Provider Demographics
NPI:1003515602
Name:COLBY AGOSTINELLI, LLC
Entity Type:Organization
Organization Name:COLBY AGOSTINELLI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:410-608-0066
Mailing Address - Street 1:912 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6211
Practice Address - Country:US
Practice Address - Phone:410-608-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty