Provider Demographics
NPI:1457640732
Name:CRAFTS COLASANTI, HOLLY CLARK (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:CLARK
Last Name:CRAFTS COLASANTI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:CLARK
Other - Last Name:CRAFTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:404 3RD ST
Mailing Address - Street 2:#D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2868
Mailing Address - Country:US
Mailing Address - Phone:347-417-0919
Mailing Address - Fax:
Practice Address - Street 1:36 PLAZA ST E
Practice Address - Street 2:SUITE #1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5048
Practice Address - Country:US
Practice Address - Phone:347-417-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist