1982095162 NPI number — MRS. COLLEEN PASSETTO MSW, LICSW

Table of content: MRS. COLLEEN PASSETTO MSW, LICSW (NPI 1982095162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982095162 NPI number — MRS. COLLEEN PASSETTO MSW, LICSW

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REARDON
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982095162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 NEW WINDSOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINSDALE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01235-9362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-655-1161
Provider Business Mailing Address Fax Number:
413-251-0551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 NEW WINDSOR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HINSDALE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-655-1161
Provider Business Practice Location Address Fax Number:
413-251-0551
Provider Enumeration Date:
02/10/2015

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:  122220 , 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)