Provider Demographics
NPI:1235835612
Name:KOLEBA, CARA ANNE
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ANNE
Last Name:KOLEBA
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 1:5952 56TH DR
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2334
Mailing Address - Country:US
Mailing Address - Phone:718-326-1294
Mailing Address - Fax:
Practice Address - Street 1:575 MADISON AVE STE 1005
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2511
Practice Address - Country:US
Practice Address - Phone:212-369-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF404695363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health