Provider Demographics
NPI:1407975105
Name:VERRIEST, COLLEEN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:
Last Name:VERRIEST
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 1:1913 ATLANTIC AVE
Mailing Address - Street 2:ROOM 195
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1029
Mailing Address - Country:US
Mailing Address - Phone:732-223-3131
Mailing Address - Fax:732-961-3048
Practice Address - Street 1:1913 ATLANTIC AVE
Practice Address - Street 2:ROOM 195
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1029
Practice Address - Country:US
Practice Address - Phone:732-223-3131
Practice Address - Fax:732-961-3048
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052848001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical