Provider Demographics
NPI:1306024682
Name:COLL, JUSTINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEONARD LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2753
Mailing Address - Country:US
Mailing Address - Phone:631-471-7301
Mailing Address - Fax:631-979-5867
Practice Address - Street 1:1 LEONARD LN
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2753
Practice Address - Country:US
Practice Address - Phone:631-471-7301
Practice Address - Fax:631-979-5867
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO38170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist