Provider Demographics
NPI:1679086920
Name:JANINE COLASUONNO, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:JANINE COLASUONNO, LICENSED MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLASUONNO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-379-2456
Mailing Address - Street 1:3 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-1404
Practice Address - Country:US
Practice Address - Phone:631-379-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000585-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty