1053759480 NPI number — MRS. COLLEEN M. SYLVESTER LICSW

Table of content: MRS. COLLEEN M. SYLVESTER LICSW (NPI 1053759480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053759480 NPI number — MRS. COLLEEN M. SYLVESTER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYLVESTER
Provider First Name:
COLLEEN
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SYLVESTER
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1053759480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 UNICORN PARK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-994-7656
Provider Business Mailing Address Fax Number:
781-994-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 UNICORN PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-994-7656
Provider Business Practice Location Address Fax Number:
781-994-7642
Provider Enumeration Date:
06/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  087930 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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