Provider Demographics
NPI:1568770873
Name:MCHORNEY, COLLEEN E (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:E
Last Name:MCHORNEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-419-3408
Mailing Address - Fax:617-534-2611
Practice Address - Street 1:1226 COLUMBIA RD
Practice Address - Street 2:#A
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-3978
Practice Address - Country:US
Practice Address - Phone:617-534-9517
Practice Address - Fax:617-534-9515
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1182901041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical