Provider Demographics
NPI:1093868044
Name:COLBATH-HESS, RICHARD L (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:COLBATH-HESS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 AMORY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1229
Mailing Address - Country:US
Mailing Address - Phone:617-354-6471
Mailing Address - Fax:
Practice Address - Street 1:79 AMORY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1229
Practice Address - Country:US
Practice Address - Phone:617-354-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10249401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical