Provider Demographics
NPI:1285224980
Name:COLON, IESHA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:IESHA
Middle Name:ALEXANDRA
Last Name:COLON
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 1:1 CHAMPS DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1883
Mailing Address - Country:US
Mailing Address - Phone:787-312-7841
Mailing Address - Fax:
Practice Address - Street 1:6339 MILL ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1427
Practice Address - Country:US
Practice Address - Phone:845-871-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool