Provider Demographics
NPI:1326177270
Name:COLPITTS, GERARD C (LICSW)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:C
Last Name:COLPITTS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:COLPITTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1965 COPPERMINE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NH
Mailing Address - Zip Code:03771-3243
Mailing Address - Country:US
Mailing Address - Phone:603-496-9375
Mailing Address - Fax:
Practice Address - Street 1:107 EASTERN AVE
Practice Address - Street 2:OCTAGON BLDG SUITE C
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2762
Practice Address - Country:US
Practice Address - Phone:603-496-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15241041C0700X
VT089.0090965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health