Provider Demographics
NPI:1558581652
Name:COLBERT, COLLEEN SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:SUSAN
Last Name:COLBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHAD ROW
Mailing Address - Street 2:SUITE D
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968
Mailing Address - Country:US
Mailing Address - Phone:845-398-8864
Mailing Address - Fax:
Practice Address - Street 1:105 SHAD ROW
Practice Address - Street 2:SUITE D
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968
Practice Address - Country:US
Practice Address - Phone:845-398-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107051103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029692OtherVALUE OPTIONS
NYP1024855OtherGHI