Provider Demographics
NPI:1508808452
Name:COLONNA, BERNARD PATRICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:PATRICK
Last Name:COLONNA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6305
Mailing Address - Country:US
Mailing Address - Phone:201-216-1614
Mailing Address - Fax:
Practice Address - Street 1:315 HUDSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1009
Practice Address - Country:US
Practice Address - Phone:212-366-8595
Practice Address - Fax:212-366-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072233-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1A841Medicare ID - Type UnspecifiedLCSW