Provider Demographics
NPI:1114642592
Name:GWEN KOLB, LICSW, LLC
Entity Type:Organization
Organization Name:GWEN KOLB, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-202-8688
Mailing Address - Street 1:275 WICKENDEN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4480
Mailing Address - Country:US
Mailing Address - Phone:401-321-4070
Mailing Address - Fax:
Practice Address - Street 1:275 WICKENDEN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4480
Practice Address - Country:US
Practice Address - Phone:401-321-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty