Provider Demographics
NPI:1053833988
Name:COLMENA, GRISELDA
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:COLMENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 PROSPECT PL APT 2H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4634
Mailing Address - Country:US
Mailing Address - Phone:347-536-1621
Mailing Address - Fax:
Practice Address - Street 1:1765 PROSPECT PL
Practice Address - Street 2:2H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233
Practice Address - Country:US
Practice Address - Phone:347-536-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator