Provider Demographics
NPI:1134321102
Name:COLBY, DAVID ARTHUR (LICSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:COLBY
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 1:17 ROUTE 129
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:NH
Mailing Address - Zip Code:03307-0814
Mailing Address - Country:US
Mailing Address - Phone:603-798-3370
Mailing Address - Fax:
Practice Address - Street 1:17 ROUTE 129
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:NH
Practice Address - Zip Code:03307-0814
Practice Address - Country:US
Practice Address - Phone:603-798-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7361041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010081Medicaid
NH30010081Medicare ID - Type Unspecified