Provider Demographics
NPI:1497997886
Name:COLON, CARLOS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:COLON
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 1:2 COURTHOUSE LN
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1715
Mailing Address - Country:US
Mailing Address - Phone:978-275-9444
Mailing Address - Fax:978-275-9918
Practice Address - Street 1:2 COURTHOUSE LN
Practice Address - Street 2:SUITE #3
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1715
Practice Address - Country:US
Practice Address - Phone:978-275-9444
Practice Address - Fax:978-275-9918
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA217873104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker