Provider Demographics
NPI:1689628547
Name:COLLARINI SCHLOSSBERG, ANTOINETTE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:MARIE
Last Name:COLLARINI SCHLOSSBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2345
Mailing Address - Country:US
Mailing Address - Phone:718-263-6028
Mailing Address - Fax:718-263-6028
Practice Address - Street 1:6739 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2345
Practice Address - Country:US
Practice Address - Phone:718-263-6028
Practice Address - Fax:718-263-6028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS7534103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR28100Medicare UPIN