Provider Demographics
NPI:1194860437
Name:COLLEARY, PATRICIA ARLENE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ARLENE
Last Name:COLLEARY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1141
Mailing Address - Country:US
Mailing Address - Phone:631-277-1523
Mailing Address - Fax:631-277-1524
Practice Address - Street 1:1227 MONTAUK HWY # 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1434
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:631-218-2650
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061846-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061846-1OtherLICCENSE #FOR SOCIAL WORK