Provider Demographics
NPI:1306184718
Name:COLTON, JENNIFER (LMHC, CASAC-T)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COLTON
Suffix:
Gender:F
Credentials:LMHC, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3303
Mailing Address - Country:US
Mailing Address - Phone:718-398-1962
Mailing Address - Fax:
Practice Address - Street 1:148 PARK PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3303
Practice Address - Country:US
Practice Address - Phone:718-398-1962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY006030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health