Provider Demographics
NPI:1407375751
Name:COLBERT, JEFFREY CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHARLES
Last Name:COLBERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 12TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3340
Mailing Address - Country:US
Mailing Address - Phone:814-201-2751
Mailing Address - Fax:814-201-2758
Practice Address - Street 1:1331 12TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3340
Practice Address - Country:US
Practice Address - Phone:814-201-2751
Practice Address - Fax:814-201-2758
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0197131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical