Provider Demographics
NPI:1588002539
Name:FOSTER, COLETTE REGINA (LMSW)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:REGINA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:STUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:10 MITCHELL AVENUE
Practice Address - Street 2:NEW HORIZONS
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903
Practice Address - Country:US
Practice Address - Phone:607-762-2229
Practice Address - Fax:607-762-2028
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker