| Gwen Kolb, Licsw, Llc | |
|
275 Wickenden St Providence RI 02903-4480 | |
| (401) 321-4070 | |
| Not Available |
| Full Name | Gwen Kolb, Licsw, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 275 Wickenden St, Providence, Rhode Island |
| Authorized Official Name and Position | Gwen Kolb (OWNER) |
| Authorized Official Contact | 6172028688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gwen Kolb, Licsw, Llc 275 Wickenden St Providence RI 02903-4480 Ph: (401) 321-4070 | Gwen Kolb, Licsw, Llc 275 Wickenden St Providence RI 02903-4480 Ph: (401) 321-4070 |
| NPI Number | 1114642592 |
|---|---|
| Provider Enumeration Date | 10/07/2022 |
| Last Update Date | 10/07/2022 |
| Certification Date | 10/07/2022 |
| Medicare PECOS PAC ID | 6507232832 |
|---|---|
| Medicare Enrollment ID | O20221012000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114642592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gwen A Kolb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598117889 PECOS PAC ID: 2163817255 Enrollment ID: I20221012000389 |
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