Provider Demographics
NPI:1609933530
Name:LIVINGSTON, COLLEEN MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MORGAN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-4235
Mailing Address - Country:US
Mailing Address - Phone:315-375-4012
Mailing Address - Fax:315-379-9162
Practice Address - Street 1:3953 STATE HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-4235
Practice Address - Country:US
Practice Address - Phone:315-375-4012
Practice Address - Fax:315-375-4013
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1244802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3105023OtherVALUE OPTION & GHI PIN #
NYAL5941251OtherDEA REGISTRATION #
NY55785BMedicare ID - Type Unspecified
NY3105023OtherVALUE OPTION & GHI PIN #