Provider Demographics
NPI:1659992345
Name:COLBERT, TAYLOR MARIE (MHC-LP)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:MARIE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 27TH ST # 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1624
Mailing Address - Country:US
Mailing Address - Phone:917-715-4452
Mailing Address - Fax:
Practice Address - Street 1:410 HALSEY ST APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-6688
Practice Address - Country:US
Practice Address - Phone:917-715-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP104306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty