Provider Demographics
NPI:1275525180
Name:COLBY, CAROL A (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:COLBY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1119
Mailing Address - Country:US
Mailing Address - Phone:518-374-7555
Mailing Address - Fax:518-374-6898
Practice Address - Street 1:196 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1227
Practice Address - Country:US
Practice Address - Phone:518-439-0033
Practice Address - Fax:518-439-7167
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051293104100000X
SC7196104100000X
CO29104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198438Medicaid
NYCC7051Medicare PIN
NY02198438Medicaid