Provider Demographics
NPI:1043980683
Name:COLOSIMO, ANNEMARIE (LISW-S)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:COLOSIMO
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3419
Mailing Address - Country:US
Mailing Address - Phone:216-533-9132
Mailing Address - Fax:
Practice Address - Street 1:6471 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-3419
Practice Address - Country:US
Practice Address - Phone:216-533-9132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00100161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical