Provider Demographics
NPI:1346353109
Name:COLONNA, ROGER D (PSYCHOLOGIST ED D)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:COLONNA
Suffix:
Gender:M
Credentials:PSYCHOLOGIST ED D
Other - Prefix:DR
Other - First Name:ROGER
Other - Middle Name:D
Other - Last Name:COLONNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:280 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044
Mailing Address - Country:US
Mailing Address - Phone:973-239-4141
Mailing Address - Fax:
Practice Address - Street 1:280 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044
Practice Address - Country:US
Practice Address - Phone:973-239-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1656103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist