Provider Demographics
NPI:1568632883
Name:COLAGRANDE, WILLIAM ROCCO (MS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROCCO
Last Name:COLAGRANDE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 FAIR ST
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3800
Mailing Address - Country:US
Mailing Address - Phone:845-339-6250
Mailing Address - Fax:
Practice Address - Street 1:275 FAIR ST
Practice Address - Street 2:SUITE 10B
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3800
Practice Address - Country:US
Practice Address - Phone:845-339-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001603-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health