Provider Demographics
NPI:1730671082
Name:COLBERT, JOSIAH DANIEL
Entity Type:Individual
Prefix:MR
First Name:JOSIAH
Middle Name:DANIEL
Last Name:COLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DODGE ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1700
Mailing Address - Country:US
Mailing Address - Phone:978-219-6798
Mailing Address - Fax:
Practice Address - Street 1:65 DODGE ST UNIT C
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1700
Practice Address - Country:US
Practice Address - Phone:978-219-6798
Practice Address - Fax:978-626-3786
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist