Provider Demographics
NPI:1053804385
Name:COLTMAN, AMBA L (LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMBA
Middle Name:L
Last Name:COLTMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:AMBA
Other - Middle Name:R
Other - Last Name:COLTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:14 WESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4218
Mailing Address - Country:US
Mailing Address - Phone:978-256-4189
Mailing Address - Fax:
Practice Address - Street 1:14 WESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4218
Practice Address - Country:US
Practice Address - Phone:978-256-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical