Provider Demographics
NPI:1790064103
Name:COLON, NELSON (LCSW)
Entity Type:Individual
Prefix:
First Name:NELSON
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 1:771 ALBANY ST
Mailing Address - Street 2:DOWLING 1 SOUTH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2525
Mailing Address - Country:US
Mailing Address - Phone:617-414-4929
Mailing Address - Fax:617-414-7759
Practice Address - Street 1:771 ALBANY ST
Practice Address - Street 2:DOWLING 1 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2525
Practice Address - Country:US
Practice Address - Phone:617-414-4929
Practice Address - Fax:617-414-7759
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical