Provider Demographics
NPI:1619055944
Name:KOLODIY, NICHOLAS C (LPC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:C
Last Name:KOLODIY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 OVERINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1838
Mailing Address - Country:US
Mailing Address - Phone:609-744-9398
Mailing Address - Fax:856-810-0819
Practice Address - Street 1:81 OVERINGTON AVE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1838
Practice Address - Country:US
Practice Address - Phone:609-744-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00306900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0048844Medicaid
NJ4144007Medicaid
NJ314011Medicare Oscar/Certification