Provider Demographics
NPI:1154446102
Name:SMITH, COLLEEN ANN (LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WESCOTT DR
Mailing Address - Street 2:HBH 5TH FL ATTN LILY
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4603
Mailing Address - Country:US
Mailing Address - Phone:908-788-6401
Mailing Address - Fax:908-788-6584
Practice Address - Street 1:2100 WESCOTT DR
Practice Address - Street 2:HBH
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4603
Practice Address - Country:US
Practice Address - Phone:908-788-6401
Practice Address - Fax:908-788-6584
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00050200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional