Provider Demographics
NPI:1770641516
Name:COLOMBINO, MAUREEN S (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:S
Last Name:COLOMBINO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 MAIN STREET
Mailing Address - Street 2:UNIT 204
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1240
Mailing Address - Country:US
Mailing Address - Phone:978-465-9139
Mailing Address - Fax:978-462-4941
Practice Address - Street 1:15 MAIN STREET
Practice Address - Street 2:UNIT 204
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-1240
Practice Address - Country:US
Practice Address - Phone:978-465-9139
Practice Address - Fax:978-462-4941
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2048OtherBCBS
MA732757OtherTUFTS
MAPO2048OtherBCBS