Provider Demographics
NPI:1578698361
Name:STANLEY, COLLEEN (LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0725
Mailing Address - Country:US
Mailing Address - Phone:516-589-1701
Mailing Address - Fax:
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:SUITE 4 MAILBOX 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:631-666-1615
Practice Address - Fax:631-666-1709
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist