Provider Demographics
NPI:1689394256
Name:COLIBRI WELLNESS, LCSW, PLLC
Entity Type:Organization
Organization Name:COLIBRI WELLNESS, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:JOVITA
Authorized Official - Last Name:SERRATO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:626-825-3492
Mailing Address - Street 1:4420 BROADWAY APT 5A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2935
Mailing Address - Country:US
Mailing Address - Phone:626-825-3492
Mailing Address - Fax:
Practice Address - Street 1:4420 BROADWAY APT 5A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2935
Practice Address - Country:US
Practice Address - Phone:626-825-3492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty